Abstract
Reflexology is a non-standardised complementary therapy practised internationally by unregulated professionals from different schools of practice, encompassing a wide range of methods and techniques.Incomplete reporting of reflexology interventions in research is a barrier to evidence-based reflexology. The aim of this thesis was to establish a foundation to enhance the quality of reporting in research involving reflexology interventions, via two objectives: (1) to develop a benchmark for evaluating the quality of reflexology reporting, and (2) to create reflexology-specific reporting guidelines for researchers to facilitate replication and reproducibility of reflexology interventions.
A systematic review was carried out on reflexology studies involving an intervention published in 2021. Six databases were searched and intervention reporting quality of eligible studies was assessed using the Template for Intervention Description and replication (TIDieR) checklist. From 421 identified references, 41 eligible studies were analysed. Of the 12 TIDieR elements, four were well-documented by most studies: ‘rationale’ (n=39), ‘how delivered’ (n=41), ‘where’ (n=39), and ‘when and how much’ (n=35). Two elements had moderate compliance: ‘tailoring or personalization’ (n=21) and ‘actual intervention fidelity’ (n=20). Four elements were poorly addressed: ‘brief name’ (n=7), ‘what materials’ (n=5), ‘what procedures’ (n=9), and ‘who delivered’ (n=10), with many studies lacking key details for replication. Two elements were rarely reported: ‘modifications during intervention’ (n=40) and ‘process for assessing intervention fidelity’ (n=36).
Using core data from this review, a three-round Delphi process was conducted with an international panel, employing an 80% consensus threshold to determine which items should be included in reflexology-specific guidance. Each Delphi round was completed by 39 to 42 (91% to 98%) of the 43 panel members, and 16 (37%) participated in the consolidation meetings. Consensus was reached on 46 items via the Delphi rounds (36 to be included in the guidance and 10 to be excluded); 38 items failed to reach consensus. The consolidation meetings informed the final wording of the guidance document.
Incomplete reporting of intervention studies presents a significant barrier to replication and undermines the capacity of systematic reviews to provide well-informed recommendations. This thesis comprises two studies aimed at addressing this issue and aims to contribute to the improvement of reporting practices. The first, published in 2024, establishes a benchmark to evaluate the quality of reflexology intervention reporting, which can be used in future assessments to track any improvements (https://doi.org/10.1016/j.eujim.2024.102391). The second study, has been published by the same journal (https://doi.org/10.1016/j.eujim.2024.102416) and is a guidance document for reflexology study authors aimed at promoting comprehensive and transparent reporting of reflexology interventions. Both studies have been registered with the Equator Network (https://www.equator-network.org/reporting-
guidelines/reflexology-specific-guidance-for-using-the-template-for-the-intervention-description-and- replication-tidier-a-delphi-study/).
| Date of Award | 19 Dec 2025 |
|---|---|
| Original language | English |
| Awarding Institution |
|
| Supervisor | Amy Drahota-Towns (Supervisor) & Joe Costello (Supervisor) |