Reflexology Science Based Medicine (EBM)
Whenever reflexology is mentioned within a clinical setting the question that always arises is where’s the evidence? If only large randomised trials are used to make science based medicine decisions then it is absolutely accepted that reflexology does not have that level of evidence. But the original Sackett definition of evidence based medicine (EBM) is:
‘the conscientious, explicit and judicious use of current best evidence in making decisions about the care of the individual patient. It means integrating individual clinical expertise with the best available external clinical evidence from systematic research.’ 
This definition actually does not define EBM as only requiring large Randomised Controlled Trials but more that the best research available together with a clinical decision should be brought into the decision making process for individual patient care. The clinical expertise originates with the health professionals involved but the patient also brings with them personal preferences and expectations that are involved in the decision-making process. It further goes on to say, that the evidence by itself, does not make the decision, but it can help support the patient care process.
The full integration of these three components into clinical decisions enhances the opportunity for optimal clinical outcomes and quality of life. EBM actually melds very well with the NHS England ‘Putting patients first’ policy, that not only should the best decision be made for that individual patient but that they themselves should be involved in the making of that decision.
With this in mind, while the best evidence about Reflexology science based medicine is not a large and comprehensive collection of research studies, neither is reflexology solely specific to one medical condition.
The very nature of reflexology as a complementary therapy means it is not condition limited, it can be used across many areas where patients are feeling stressed, anxious or in pain and/ or need a boost to their quality of life and wellbeing. This lack of specificity does not bode well for research meta-analyses, and when meta-analysis for complementary therapies is undertaken it usually results in a negative outcome. This does not necessarily mean that reflexology has no worth but rather that its action is too heterogeneous to be successfully analysed using this system.
If, however, the existing best evidence; that of the separate research studies are taken into account, then it can be seen that there is potential in this low cost, supportive therapy. Potential that could help care for patients in a way that perhaps is missing from the present-day NHS.
 Science-based medicine David L. Sackett Seminars in Perinatology Volume 21, Issue 1, February 1997, Pages 3-5
 Meta-analysis: Its strengths and limitations Esteban Walker, Adrian V. Hernandez, Micheal W. Kattan Cleveland Clinic Journal of Medicine. 2008 June;75(6):431-439
Long term conditions
Conditions, especially long term ones, can be a complex vortex of illness, pain, anxiety, depression, emotions and needs. Standard medical care does not cope well with complexity as it rather follows straight paths as compared to swirling spirals. There is evidence that people with long term conditions receive poorer quality of care than those with a single condition.