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Licensed Unlicensed Requires Authentication Published by De Gruyter April 12, 2021

The effects of foot massage on hemodialysis patients’ sleep quality and restless leg syndrome: a comparison of lavender and sweet orange essential oil topical application

Khodayar Oshvandi, Fariba Mirzajani Letomi, Ali Reza Soltanian and Morteza Shamsizadeh



Hemodialysis (HD) patients suffer more sleep problems (poor sleep quality and restless leg syndrome [RLS]). Complementary therapy, especially massage with aromatherapy oil is one of the non-pharmacological treatment options with less adverse effects than routine methods. The purpose of this study was to determine the effects of foot massage with of lavender and orange essential oil on HD patients’ sleep quality and RLS.


This is a double blind randomized controlled trial on 105 HD patients was conducted at a large educational hospital in Iran, Hamadan province between January and September 2017. Patients divided into three groups with random allocation (35 participants per groups in lavender, orange, and control group). Foot massage during HD with lavender and orange essential oil was administered to the patients three times a week for three weeks, and every massage lasted half an hour. The control group received routine care. Before the intervention, the end of the first, second, and third weeks Pittsburgh Sleep Quality Index (PSQI) and RLS questionnaire were completed for all three groups. Data were statistically analyzed with Independent Samples t-test, chi-square test and repeated-measures analysis of variance (ANOVA) by SPSS version 16.


The mean score of sleep quality and RLS in the intervention groups were significantly different compare with the control group in all three time of data collecting (p<0 001).


Aromatherapy prepared with lavender oil and sweet orange may be recommended to increase sleep quality and RLS level of the HD patients.

Corresponding author: Morteza Shamsizadeh, Chronic Diseases (Home Care) Research Center, Hamadan University of Medical Sciences, Hamadan, Iran, E-mail:

Funding source: Hamadan University of Medical Sciences

Award Identifier / Grant number: 9606143744


The present paper was derived from a Master of Science (MSc) thesis in nursing. The author wishes to thank the nursing research center and the deputy of research and technology in Hamadan University of Medical Sciences and also wishes to acknowledge his gratitude to the faculty members of School Nursing and Midwifery, patients, supervisors and nurses of hemodialysis wards.

  1. Research funding: Hamadan University of Medical Sciences financially supported this study (grant number: 9606143744).

  2. Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.

  3. Competing interests: No funding organizations played a role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.

  4. Ethical approval: Ethical approval for this study was obtained from the Committee of Ethics of the Hamadan University of Medical Sciences, Hamadan, Iran (#IR.UMSHA.REC.1396.315). This study was registered under the Iranian Registry of Clinical Trials (#IRCT2017071532303N3) (available at


1. Rodriguez, A, Shalhub, S. Hemodialysis access: fundamentals and advanced management. Hemodialysis access. Switzerland: Springer; 2017:281–8 pp.10.1007/978-3-319-40061-7_33Search in Google Scholar

2. Kim, Y-L, Kawanishi, H. The essentials of clinical dialysis. Singapore: Springer; 2018.10.1007/978-981-10-1100-9Search in Google Scholar

3. Mollahadi, M, Tayyebi, A, Ebadi, A. Comparson of anxiety, depression and stress among hemodialysis and kidney transplantation patients. Iran J Crit Care Nurs 2010;2:153–6.Search in Google Scholar

4. Coresh, J. Update on the burden of CKD. J Am Soc Nephrol 2017;28:1020. in Google Scholar PubMed PubMed Central

5. Otaghi, M, Hassani, P, Zaghari tafrreshi, M, Nikbakht nasrabadi, A. Challenge in acceptance of heamodialysis: a part of a grounded theory. J Res Dev Nurs Midwifery 2013;10:26–34.Search in Google Scholar

6. Arab, Z, Shariati, A, Bahrami, H, Asayesh, H, Vakili, M. The effect of acupressure on quality of sleep in hemodialysis patients. J Nurs Midwifery Urmia Univ Med Sci 2012;10:237–45.Search in Google Scholar

7. Sarris, J, Byrne, GJ. A systematic review of insomnia and complementary medicine. Sleep Med Rev 2011;15:99–106. in Google Scholar PubMed

8. Liaveri, PG, Dikeos, D, Ilias, I, Lygkoni, EP, Boletis, IN, Skalioti, C, et al.. Quality of sleep in renal transplant recipients and patients on hemodialysis. J Psychosom Res 2017;93:96–101. in Google Scholar PubMed

9. Farrokhian, R, Solimani, M-A, Sheikhi, M-R, Alipour, M. Effect of foot reflexology massage on sleep quality in hemodialysis patients: a randomized control trial. Sci J Hamadan Nurs Midwifery Facul 2016;24:213–20.10.21859/nmj-24041Search in Google Scholar

10. Baraz, S, Mohamadi, E, Broomand, B. Relationship of sleep quality, quality of life and blood factors in preservative hemodialysis patients. J Shahrekord Med Sci Univ 2007;9:67–74.Search in Google Scholar

11. Stefanidis, I, Vainas, A, Giannaki, C, Dardiotis, E, Spanoulis, A, Sounidaki, M, et al.. Restless legs syndrome does not affect 3-year mortality in hemodialysis patients. Sleep Med 2015;16:1131–8. in Google Scholar PubMed

12. Spolador, T, Allis, JC, Ponde, MP. Treatment of restless legs syndrome. Rev Bras Psiquiatr 2006;28:308–15. in Google Scholar

13. Stefanidis, I, Vainas, A, Dardiotis, E, Giannaki, C, Gourli, P, Papadopoulou, D, et al.. Restless legs syndrome in hemodialysis patients: an epidemiologic survey in Greece. Sleep Med 2013;14:1381–6. in Google Scholar PubMed

14. Kushida, C, Martin, M, Nikam, P, Blaisdell, B, Wallenstein, G, Ferini-Strambi, L, et al.. Burden of restless legs syndrome on health-related quality of life. Qual Life Res 2007;16:617–24. in Google Scholar PubMed

15. Mucsi, I, Molnar, MZ, Ambrus, C, Szeifert, L, Kovacs, AZ, Zoller, R, et al.. Restless legs syndrome, insomnia and quality of life in patients on maintenance dialysis. Nephrol Dial Transplant 2005;20:571–7.10.1093/ndt/gfh654Search in Google Scholar PubMed

16. Strandås, M, Wackerhausen, S, Bondas, T. The nurse–patient relationship in the New Public Management era, in public home care: a focused ethnography. J Adv Nurs 2019;75:400–11. in Google Scholar PubMed

17. Sagheb, MM, Dormanesh, B, Fallahzadeh, MK, Akbari, H, Nazari, SS, Heydari, ST, et al.. Efficacy of vitamins C, E, and their combination for treatment of restless legs syndrome in hemodialysis patients: a randomized, double-blind, placebo-controlled trial. Sleep Med 2012;13:542–5. in Google Scholar PubMed

18. Hassanzadeh, M, Kiani, F, Bouya, S, Zarei, M. Comparing the effects of relaxation technique and inhalation aromatherapy on fatigue in patients undergoing hemodialysis. Compl Ther Clin Pract 2018;31:210–4. in Google Scholar PubMed

19. Horigan, AE, Schneider, SM, Docherty, S, Barroso, J. The experience and self-management of fatigue in patients on hemodialysis. Nephrol Nurs J 2013;40:113–22.Search in Google Scholar

20. Horigan, AE. Fatigue in hemodialysis patients: a review of current knowledge. J Pain Symptom Manag 2012;44:715–24. in Google Scholar PubMed

21. Muz, G, Taşcı, S. Effect of aromatherapy via inhalation on the sleep quality and fatigue level in people undergoing hemodialysis. Appl Nurs Res 2017;37:28–35. in Google Scholar PubMed

22. Rao, ASA, Phaneendra, D, Pavani, CD, Soundararajan, P, Rani, NV, Thennarasu, P, et al.. Usage of complementary and alternative medicine among patients with chronic kidney disease on maintenance hemodialysis. J Pharm BioAllied Sci 2016;8:52.10.4103/0975-7406.171692Search in Google Scholar PubMed PubMed Central

23. Jeon, HO, Kim, BH, Kim, O. Illness uncertainty and complementary and alternative medicine use in patients undergoing hemodialysis. Nurs Health Sci 2019;21:375–81. in Google Scholar PubMed

24. Price, L, Price, S. Aromatherapy for health professionals E-book. Philadelphia: Elsevier Health Sciences; 2011.Search in Google Scholar

25. Rhind, JP. Essential oils: a handbook for aromatherapy practice, 2nd ed. London: Singing Dragon; 2012.Search in Google Scholar

26. Shannon, S. Handbook of complementary and alternative therapies in mental health. San Diego: Elsevier; 2002.Search in Google Scholar

27. Gnatta, JR, Kurebayashi, LFS, Turrini, RNT, Silva, MJP. Aromatherapy and nursing: historical and theoretical conception. Rev Esc Enferm USP 2016;50:127–33. in Google Scholar PubMed

28. Cavanagh, H, Wilkinson, J. Biological activities of lavender essential oil. Phytother Res 2002;16:301–8. in Google Scholar PubMed

29. Beyliklioğlu, A, Arslan, S. Effect of lavender oil on the anxiety of patients before breast surgery. J PeriAnesthesia Nurs 2019;34:587–93. in Google Scholar PubMed

30. Chen, SL, Chen, CH. Effects of Lavender tea on fatigue, depression, and maternal-infant attachment in sleep-disturbed postnatal women. Worldviews Evidence-Based Nurs 2015;12:370–9. in Google Scholar PubMed

31. Goes, TC, Antunes, FD, Alves, PB, Teixeira-Silva, F. Effect of sweet orange aroma on experimental anxiety in humans. J Alternative Compl Med 2012;18:798–804. in Google Scholar PubMed

32. Jafarzadeh, M, Arman, S, Pour, FF. Effect of aromatherapy with orange essential oil on salivary cortisol and pulse rate in children during dental treatment: a randomized controlled clinical trial. Adv Biomed Res 2013;2. in Google Scholar PubMed PubMed Central

33. Bauer, BA, Cutshall, SM, Wentworth, LJ, Engen, D, Messner, PK, Wood, CM, et al.. Effect of massage therapy on pain, anxiety, and tension after cardiac surgery: a randomized study. Compl Ther Clin Pract 2010;16:70–5. in Google Scholar PubMed

34. Sentürk, A, Kartin, PT. The effect of lavender oil application via inhalation pathway on hemodialysis patients’ anxiety level and sleep quality. Holist Nurs Pract 2018;32:324–35.10.1097/HNP.0000000000000292Search in Google Scholar PubMed

35. Bagheri-Nesami, M, Espahbodi, F, Nikkhah, A, Shorofi, SA, Charati, JY. The effects of lavender aromatherapy on pain following needle insertion into a fistula in hemodialysis patients. Compl Ther Clin Pract 2014;20:1–4. in Google Scholar PubMed

36. Ghods, AA, Abforosh, NH, Ghorbani, R, Asgari, MR. The effect of topical application of lavender essential oil on the intensity of pain caused by the insertion of dialysis needles in hemodialysis patients: a randomized clinical trial. Compl Ther Med 2015;23:325–30. in Google Scholar PubMed

37. Shahgholian, N, Dehghan, M, Mortazavi, M, Gholami, F, Valiani, M. Effect of aromatherapy on pruritus relief in hemodialysis patients. Iran J Nurs Midwifery Res 2010;15:240.Search in Google Scholar

38. Hashemi, SH, Hajbagheri, A, Aghajani, M. The effect of massage with lavender oil on restless leg syndrome in hemodialysis patients: a randomized controlled trial. Nurs Midwifery Stud 2015;4:1–5. in Google Scholar PubMed PubMed Central

39. Ilter, SM, Ovayolu, Ö, Ovayolu, N. The effect of inhaler aromatherapy on invasive pain, procedure adherence, vital signs, and saturation during port catheterization in oncology patients. Holist Nurs Pract 2019;33:146–54.10.1097/HNP.0000000000000322Search in Google Scholar PubMed

40. Heydari, N, Abootalebi, M, Jamalimoghadam, N, Kasraeian, M, Emamghoreishi, M, Akbarzadeh, M. Investigation of the effect of aromatherapy with Citrus aurantium blossom essential oil on premenstrual syndrome in university students: a clinical trial study. Compl Ther Clin Pract 2018;32:1–5. in Google Scholar

41. Xiong, M, Li, Y, Tang, P, Zhang, Y, Cao, M, Ni, J, et al.. Effectiveness of aromatherapy massage and inhalation on symptoms of depression in Chinese community-dwelling older adults. J Alternative Compl Med 2018;24:717–24. in Google Scholar

42. Hekmatpou, D, Pourandish, Y, Farahani, PV, Parvizrad, R. The effect of aromatherapy with the essential oil of orange on pain and vital signs of patients with fractured limbs admitted to the emergency ward: a randomized clinical trial. Indian J Palliat Care 2017;23:431. in Google Scholar

43. Rashidi-Fakari, F, Tabatabaeichehr, M, Mortazavi, H. The effect of aromatherapy by essential oil of orange on anxiety during labor: a randomized clinical trial. Iran J Nurs Midwifery Res 2015;20:661. in Google Scholar

44. Buysse, DJ, Reynolds, CFIII, Monk, TH, Berman, SR, Kupfer, DJ. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatr Res 1989;28:193–213. in Google Scholar

45. Mindell, JA, Cook, RA, Nikolovski, J. Sleep patterns and sleep disturbances across pregnancy. Sleep Med 2015;16:483–8. in Google Scholar PubMed

46. Sharon, D, Allen, RP, Martinez-Martin, P, Walters, AS, Strambi, LF, Högl, B, et al.. Validation of the self-administered version of the international Restless Legs Syndrome study group severity rating scale–the sIRLS. Sleep Med 2019;54:94–100. in Google Scholar PubMed

47. Santos, RSS, Moyses, RMA, Elias, RM. Impact of Restless Leg Syndrome on mortality in patients on hemodialysis: still debatable. Sleep Med 2016;22:102. in Google Scholar PubMed

48. Walters, AS, Aldrich, MS, Allen, R, Ancoli-Israel, S, Buchholz, D, Chokroverty, S, et al.. Toward a better definition of the restless legs syndrome. Mov Disord 1995;10:634–42. in Google Scholar PubMed

49. Turk, AC, Ozkurt, S, Turgal, E, Sahin, F. The association between the prevalence of restless leg syndrome, fatigue, and sleep quality in patients undergoing hemodialysis. Saudi Med J 2018;39:792. in Google Scholar PubMed PubMed Central

50. Eftekhari, A, Nasiriani, K, Mirzaei, S, Ardakani, SA. Predictive factors of restless leg syndrome in hemodialysis patients. J Ren Inj Prev 2016;5:89. in Google Scholar PubMed PubMed Central

51. Shahgholian, N, Jazi, SK, Karimian, J, Valiani, M. The effects of two methods of reflexology and stretching exercises on the severity of restless leg syndrome among hemodialysis patients. Iran J Nurs Midwifery Res 2016;21:219. in Google Scholar PubMed PubMed Central

52. Kashani, F, Kashani, P. The effect of massage therapy on the quality of sleep in breast cancer patients. Iran J Nurs Midwifery Res 2014;19:113.Search in Google Scholar

53. Roshanravan, M, Jouybari, L, Bahrami Taghanaki, H, Vakili, M, Sanagoo, A, Amini, Z. Effect of foot reflexology on fatigue in patients undergoing hemodialysis: a sham-controlled randomized trial. J Mazandaran Univ Med Sci 2016;26:32–41.Search in Google Scholar

54. Aghabati, N, Mohammadi, E, Pour Esmaiel, Z. The effect of therapeutic touch on pain and fatigue of cancer patients undergoing chemotherapy. Evid base Compl Alternative Med 2010;7:375–81. in Google Scholar PubMed PubMed Central

55. Balouchi, A, Masinaeinezhad, N, Abdallahimohammad, A, Firouzkouhi, MR, Sepehri, Z. Comparison of effects of orange and lavender extract on fatigue in hemodialysis patients. Der Pharm Lett 2016;8:50–4.Search in Google Scholar

Supplementary Material

The online version of this article offers supplementary material (

Received: 2020-04-16
Accepted: 2020-09-02
Published Online: 2021-04-12

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