An investigation and comparison of the effects of self-care education with effleurage massage of feet, hydrotherapy, and leg elevation on the physiological status of the feet in pregnant women: A Randomized Clinical Trial
Authors: Asadi Fatemeh , Simbar Masoumeh , Zahrani Shahnaz Tork , Nasiri Maliheh 
Published: September 2023

Abstract
Background
Feet edema in the third trimester is a common occurrence, and approximately 70% of pregnant women experience it. Physiologic edema in the feet can cause discomfort such as a feeling of heaviness, muscular cramps at night, a tingling sensation, pain and discomfort when walking, and fatigue in the feet, affecting 80% of pregnant women with edema in feet. These problems can lead to reduced activity levels in pregnant women and increase the risk of complications such as thromboembolism. Non-pharmaceutical methods such as massage therapy, hydrotherapy, elevating the feet, reflexology, bandaging the feet, and feet exercises have been used to improve physiologic edema in pregnancy without any adverse effects reported for the mother or the fetus. None of these methods have been studied and compared in a self-care context. Therefore, the present study aimed to determine and compare the effects of self-care education with massage therapy, hydrotherapy, and leg elevation on physiologic edema in pregnancy.
Method
The study was a randomized controlled trial conducted on eligible 129 primigravid women who visited the Mahdieh Tehran Health Center. A systematic random sampling method was used to recruit the samples and devoting them to four groups: hydrotherapy, massage therapy, leg elevation, and control. The data collection tools included a demographic and obstetric questionnaire, a pre- and post-intervention observation and examination checklist, an adverse events and satisfaction with intervention questionnaire, and a non-elastic meter. The validity and reliability of the tools were confirmed. The intervention groups performed self-care interventions daily for 20 minutes for 5 consecutive days. The control group received only routine prenatal care. Outcome variables were compared before and after the intervention among all intervention and control groups. After data collection, the data were analyzed using statistical analyses with SPSS-24.
Findings:
The paired t-test showed a significant reduction in the circumference of the right and left feet triple sites (ankle joint, instep, and metatarsophalangeal joint) after the intervention compared to before the intervention within each study group (P < 0.001). The results of the analysis of covariance indicated a significant difference in the mean size of foot circumferences after the intervention among the groups (P < 0.001). Pairwise comparison of foot circumferences within the study groups after the intervention using the Bonferroni test also showed that leg elevation through self-care had the greatest effect compared to other interventions (P < 0.001).
Conclusions
The results showed that self-care interventions including therapeutic massage (effleurage massage), hydrotherapy, and leg elevation were effective in improving physiological edema in the legs during pregnancy. Furthermore, leg elevation was found to be more effective in reducing the size of foot circumferences and degree of leg edema compared to other self-care interventions, and effleurage massage had the least effect in improving physiological edema in pregnancy. It seems that in terms of execution technique, leg elevation is simpler than other interventions, and all individuals can easily perform it correctly without the need for assistance from others. Therefore, it can be considered the simplest, most practical, and most effective self-care method for improving physiological edema during pregnancy. It can be recommended as the first option compared to the other three methods.
Trial registration:
The present study was approved by the Ethics Committee of Shahid Beheshti University of Medical Sciences with the ethics code: IR.SBMU.PHARMACY.REC.1400.307 (22/02/2022), then it was registered in the Clinical Trial Center of Iran (with the code: IRCT20220302054163N1) (14/03/2022).