ARCB :: American Reflexology Certification Board

Alternative and complementary therapies are being increasingly considered within healthcare professions. Reflexologists with the highest standards of credentials are sought by the public and the healthcare industry who view Reflexology as a valuable and noninvasive therapy. With this acceptance of Reflexology comes the responsibility of the profession to provide qualified practitioners who meet established national standards. In recognition of this responsibility, leaders in Reflexology created the American Reflexology Certification Board (ARCB) in 1991.

ARCB is a nonprofit corporation. As an independent testing agency, it offers a national certification program. Its primary purpose is to certify the competency of those reflexologists who practice on a professional basis and wish to be recognized as meeting national standards. Reflexologists who voluntarily engage in the national certification process promote higher standards of education, ensure public safety, and continue to demonstrate their commitment to their profession through self-improvement / continuing education. Through the identification of nationally certified Reflexology practitioners, confidence has been assured in the quality of the services offered.

The First ARCB Examination

During the 1989-1990 timeframe, prior to the incorporation of ARCB, leaders in the Reflexology profession got together and surveyed other professional reflexologists across the United States. The survey asked the following questions: 1) What basic information is necessary for the professional reflexologist to understand and know; and 2) What information is necessary so that the national certification standards of the ARCB are not only respected by the Reflexology profession, but also by other professions. The results of this survey formed the content domains to be covered in the examination and identified the necessity for both the practical (“hands-on”) and documentation portions of the test.

The results indicated that content domains to be tested should include Anatomy and Physiology, Professional Standards and Ethics, Reflexology History, Anatomical Systems and Terminology and all aspects of Reflexology. The Practical test was to assess “hands-on” skills and practitioner - client communication skills relevant to Reflexology. The Documentation portion was to evaluate the applicant’s ability to document and make professional assessments.

The newly established ARCB Board of Directors, practitioners, nationally known Reflexology educators and other respected leaders in Reflexology in the U.S. served as subject matter experts (SME’s) in the development of the initial certification examination. With the survey results as a guide, they used common information found in multiple Reflexology sources and designed the examination in accordance with the American standard of Reflexology knowledge, techniques and documentation. The lack of relevant educational standards at the time of this test development process highlighted the need for a Study Guide Outline to ensure that all candidates had access to the same information/materials. An initial version of the Study Guide Outline was compiled concurrently with the test development by those not engaged directly in item preparation.

The written test items were constructed using both True/False and four-option Multiple Choice formats. SME’s for each domain wrote the items while others not participating in writing, reviewed, “tested” and edited the items. 300 items were selected for the written test with a performance standard of 80% (240 items correct) required for Passing. The selection of 80% as a “cut score” for Passing vs. Failing the Written portion was based on the discussions with school owners and teachers of Reflexology programs offering school-based certifications to their students (upon completion of instruction, success on his/her examination and documented “hands-on” practice hours). Many school programs used the performance standard of 70% required for Passing. It was agreed that a national standard should be higher.

Reflexology is a specialized “manual” touch therapy. As such, the Practical portion was designed to test the “hands-on” skills and practitioner/client skills relevant to Reflexology. Pressure, flow, American standard reflex locations and thumb and finger walking as well as communication skills are assessed. The candidate “works” for approximately 30 minutes on the proctor. An exact protocol for the Practical portion of the exam was developed for use by all proctors. To ensure consistency in scoring the Practical portion, members of the ARCB Board of Directors who would be proctoring the examinations engaged in a process of “inter-rater reliability” by comparing their evaluations of the “hands-on” abilities of the same reflexologist. (It should be noted that this consistency check occurs annually and whenever a new proctor is added to the roster.) The Practical test is scored on a scale of 1 “Excellent” – 5 “Failure”. A score less than or equal to 3 “Average” is required to pass.

The Documentation portion of the examination consists of the submission of 30 sets of documentations (30 clients seen three times each). A specific form to be used for these documentations was designed in keeping with American standards of documentation. Progress notes are documented using the SOAP note protocol. The details and criteria for completion of this portion of the exam are described explicitly in the Study Guide Outline. Samples are also provided. The Documentation portion is graded on a Pass/Fail basis.

The ARCB Board of Directors in concert with the reflexologists who participated in the development of the examination decided that a candidate must pass all three portions of the test to complete the certification program. In the event of a candidate failing any portion of the test (i.e. Written, Practical or Documentation), only the failed part would need to be retaken.

The first national administration of the ARCB certification examination was in January 1992. Forty candidates participated. A second administration followed in August of that same year. A “Test Comment Sheet” was developed and was given to each candidate along with his/her examination booklet to elicit feedback about the certification program and the actual examination including specific items. (Note: Due to the valuable nature of the feedback gathered in the early years of the ARCB certification program, the “Test Comment Sheet” continues to be used. The sheets, when summarized, have become a viable part of the annual test review process.)

The 1994 National Job Survey

In June 1994 ARCB conducted a more in-depth survey which was sent to ARCB certificants, members of national and state level Reflexology associations via their newsletters and other reflexologists. The survey addressed practices of reflexologists including various “hands-on” modality techniques and assessment techniques used in the course of their work. The survey also asked practitioners about their beliefs about how Reflexology “works”, practice models followed, and Reflexology’s “scope of practice”. The importance of each of these aspects was inferred based on the respondent’s level of usage in the case of a practice or modality or in the case of a theory, the strength of agreement with that particular theory. In addition to “typical” demographics (age, educational status, gender, etc.), respondents provided information specific to their practice of Reflexology as a profession.

The summarized results of the 140 responding reflexologists served as further support and evidence of the content-related validity of the ARCB certification examination. These results combined with the demographics yielded the following “Profile of the Average/Typical Reflexologist” in practice at that time:

"Jane Doe is a 52 year old Caucasian female who is self-employed and a California urban resident. She has been practicing for 9 years and sees about 13 clients a week from her in-home office for approximately 52 minutes each. Her fee is $36 a session and her annual income is $24,336. Jane has some college and her initial schooling in Reflexology came through attendance at a 41 hour seminar from which she is certified. Over the years she has continued her education through seminars and workshops and is a member of several associations. As far as technique goes, she uses thumb walking the majority of the time on the feet and hands and often combines Reflexology with massage. However, she does exercise constraint and feels there are times when Reflexology should not be used even though she works on her clients to primarily reduce stress. Philosophically she believes that Reflexology has an effect on the physical body, emotions, mind and soul of the person by working through the anatomical systems of the body. She would never use oils or tools, believing Reflexology is the application of human touch to the foot of the person."

Program Continuity and Stability

Candidate comments provided as part of the examination process address the Study Guide Outline (content and organization) and the ease and relevance of the Written, Practical and Documentation portions of the examination. For the first six years of the program, the annual compilation and review of these comments led to a few of the test items being rewritten and associated revisions to the content of the Study Guide Outline. The most common overall comment was – and continues to be – that the test is “fair”. Consistent positive responses have been given to the question “Were the questions pertinent to the knowledge you feel a professional reflexologist should know?” Candidates have the option of commenting anonymously. Most have chosen to sign their forms. The current version of the examination has been in use since mid-1998. The Study Guide Outline was revised most recently in early 1999.

The Current ARCB Examination: Psychometrics

The current ARCB certification examination has been used since mid-1998. The content areas represented are Anatomy and Physiology (33.3%), Professional Standards and Ethics (16.7%), Reflexology (33.3%) and Reflex Locations (16.7%). Total written scores, individual responses to all Written items, Practical scores and Documentation scores (if completed) for 517 ARCB candidates/certificants served as data in the derivation of scoring summary statistics and assessment of the examination’s internal consistency reliability. Demographics were gathered from the applications as submitted to the ARCB office.

Demographics (based to those responding):

Average Age: 43 (range 21 – 71; median 44)

Ethnicity: African American: 3%

Asian/Pacific Islander: 3%

Caucasian: 90%

Hispanic: 3%

Other: LT 1%

Gender: Male: 8%; Female: 92%

Physically Disabled: 1%

Certified through their school program: 76%

Average number of years practicing Reflexology (if already in practice): 2

Full Time Practice: 19%; Part Time Practice: 81%

Education Status: High School: 16%

Some College: 20%

2 Year Degree: 16%

4 Year Degree: 32%

MS/MA: 14%

Ph.D./Ed.D./Psy.D.: 2%

Professional memberships: 35% listed one or more

Related training courses beyond their initial training: 53% listed one or more courses. 47% responding “zero/none” is a reflection that many candidates for ARCB certification apply immediately upon receiving their school-based certification or completing their school program.

Scoring Summary Statistics:

Written Portion (N = 517):

Mean score: 88.6; Standard Deviation: 4.399

Range: 70 – 97

The “cut score” of 80% yields a 98.5% pass rate. Only 8 candidates received a score less than 80.

The potential effects of adjusting the cut score upward (based on the current sample of 517):

Cut Score Pass % Fail %

83 88% 12%

85 78% 22%

87 68% 32%

90 44% 56%

The cut score of 80% on the Written portion of the examination is a standard believed to be “high enough to protect the public, as well as the practitioner, but not so high as to be unreasonably limiting.” (AERA, 1999, p.157)

Practical Portion (N = 517):

Mean score: 2.4; Standard Deviation: .4364

Range: 1.1 – 3.4

A score less than or equal to 3 is considered “passing”. Only two candidates scored above “3” yielding a Pass rate of 99.6% and a Fail rate of .4%.

Documentation Portion (N = 498):

The difference in sample N’s reflects those who did not turn in their 90 required Documentation forms (3.7%). The Documentation portion is graded Pass/Fail. 97% turned in “Passing” Documentation forms. 3% did not.

Test Reliability

The complete ARCB examination was subjected to a test of internal consistency reliability. Written items were transformed to binary (correct response vs. not). Due to the extremely high Pass rate of the Practical portion, that data also was transformed to binary “Pass-Fail” for the purpose of the analysis. Data from the 498 candidates with complete examinations yielded a coefficient of internal consistency Alpha value of .84.

The standard error of measurement (SEM) is estimated to be 4.7. For the purpose of this analysis it is assumed that the random errors of measurement associated with each candidate are normally distributed. Under this assumption, using the estimated value of the SEM to create a confidence interval around a candidate’s observed score, one can be 68% confident that the average candidate’s “true” score lies within the interval of his/her observed score +/- 4.7.

Crocker and Algina (1986) note that the standard error of measurement is useful as an estimate of how far the “true” score may lie from an observed score for an average individual taking a particular test (i.e., candidate for ARCB certification). However, there’s no absolute guarantee that an individual candidate’s “true” score really falls in the confidence interval generated around his/her observed score. The value of the SEM reflects an average of many candidates’ individual standard errors. As such, it’s not realistic to believe that these standard errors are equivalent for all candidates in the ARCB certification program.

The Demographics were checked on the sample of 498 candidates used in the reliability analysis. Shifts of 1% each were observed in three categories of Education Status: High School: 16% to 15%; 4 Year Degree: 32% to 33% and MS / MA: 14% to 15%. All other Demographics remained unchanged. Written score summary statistics are as follows: Mean score: 89, Standard Deviation: 4.02; Range: 79 – 97.

The Current ARCB Examination: Test Comment Sheet Summary

Annual reviews of the Test Comment Sheets by the ARCB Board of Directors have not resulted in changes to the ARCB examination since 1998. The comments of 500 candidates who took the 1998 examination over the past five years were summarized. Overall, the ARCB examination process is seen as fair, professional and complete. Highlights from this analysis are as follows:

The responses to the question “Why did you want to become ARCB certified?” fall into two descriptive categories: (1) ARCB is seen as a complete and respected standard adding credibility to the profession. Some specific comments…

- national exam is important for the validity of the profession

- raises the bar of professionalism of Reflexology

- to support the advancement of Reflexology

- to help promote Reflexology

- to further the professionalism of Reflexology

- to add credibility to Reflexology as a profession

- important that Reflexology is respected and validated which is accomplished by first respecting the public’s safety – ARCB enables that

- having standards for reflexologists can only help and encourage our field to be accepted by the public and to help the education of the public to what we do; shows my dedication to this for going through the process

(2) ARCB certification enhances the individual practitioner’s credibility, quality and professionalism. Some specific comments…

- to enhance my professional status in Reflexology

- the backing of a national board improves my professionalism

- to enhance my credibility as a practitioner

- so that I can represent myself as a professional

- to be the most professional I can be

- to attain the highest level in the profession

- ARCB is the highest level of professionalism available

- personal desire to be held accountable to standards of practice

- desire to adhere to professional standards and practice

- want to be part of the highest standards associated with Reflexology

- want to be part of a national program of accountability in Reflexology

- to be part of ethical work standards

- want to be the best I can be for my clients – ARCB national certification enables that

- ARCB enables personal and professional growth

The ARCB Study Guide Outline is evaluated with respect to its “ease of use” on the 1 to 5 scale where “1” is labeled “Easy” and “5” is labeled “Very difficult”. The average rating of 461 candidates’ responses is 2.5. Only 15% rated the Study Guide “4” or above. Almost everyone responds positively regarding the Study Guide’s organization and content. There are very few comments otherwise. A few candidates indicated that the History section doesn’t seem “to flow” and could be better organized or re-worded – perhaps by using “bullet points”.

The small number of responses to the question “What other information, which is in print, do you feel the professional reflexologist needs to know?” mostly concern Anatomy and Physiology (systems of the body) and the anatomy of the foot (bones, muscles, tendons, etc.). The reasons given emphasize that this knowledge would increase awareness of the client’s condition(s).

The ARCB Written examination is evaluated regarding its “ease” on the 1 to 5 scale where “1” is labeled “Easy” and “5” is labeled “Very difficult”. The average rating of 490 candidates’ responses is 3.2. 85% rated the Written portion “3” or above with 55% choosing “3”, the midpoint of the range. Candidates consistently respond positively when asked “Were the questions pertinent to the knowledge you feel a professional reflexologist should know?”.

Although some candidates state that they would prefer fewer than 90 required Documentation sessions, the majority who comment indicate that the structured forms and the discipline associated with them have been beneficial in their work as a Reflexology practitioner. Many view the forms as a “must” for keeping track of their clients’ progress and state that they’ll continue to use them.

Those candidates who comment regarding the Practical portion of the examination appreciate the patience, support and calming natures of the proctors at “a very stressful time”. The questions asked as part of the Practical portion are perceived as relevant, straightforward and fair. Many candidates report that the Practical examination isn’t as intimidating as they thought it would be.

The 2001 National Job Analysis Survey

In the Spring of 2001, the ARCB Board of Directors developed a survey to assess in-depth the “practice” of Reflexology (Session Techniques, Client Assessment, and Reflexology Theory), education and testing aspects of Reflexology and to gather demographic information from those in the profession. The survey was sent to all 536 certificants (at the time), 100 non-duplicate members of the Reflexology Association of America and 25 other reflexologists. 176 (26.7%) of the 661 surveys were returned from reflexologists in 33 states around the U.S; 26 respondents are teachers of Reflexology.

In addition to summary statistics, the results for each item were analyzed by the categories of Teacher vs. Not, Hours of Training, ARCB Certified vs. Not, Self-employed vs. Not, Full- vs. Part-time Practitioner, Primary Income from Reflexology vs. Not, Gender, Age Group, Maintain Currency via Continuing Education vs. Not, and by State in which they practice. The evaluation yielded the following profile.

“Based on the responses provided the “typical” Reflexologist is a 49 year old,

Caucasian female who is self-employed and living in a suburban area of New

York. “Nancy” has been practicing for 8 years and sees about 12 clients per week

in her home office. Her sessions last an hour for which she charges $47. Her

annual income from Reflexology is $28,200. In addition to her “formal” education

from which she has a four-year degree, Nancy’s initial Reflexology training

consisted of a 200 hour program. As a proponent of continuing education, she

believes that nationally certified reflexologists should complete at least 10 hours

of continuing education per year. Nancy has continued her own education through

workshops and seminars as well as through her attendance at the professional

conferences held by the various state, national and international Reflexology

associations of which she is a member.

During the course of her sessions Nancy varies the pressure during her thumb

and finger movements as she works the reflex areas, and is careful to check with

her clients regarding their pressure preferences. She doesn’t use tools and rarely

uses lubricants during a session. Nancy always works on the feet and typically

works both feet completely. Although Nancy does incorporate work on the hands

into her sessions, she’s less apt to work on the ears. Following a code of ethics,

she doesn’t provide psychological counseling, but does engage in active listening.

Even though Nancy primarily follows a combination of the stress-reduction and

energy models of Reflexology, she believes that there are contraindications for

Reflexology. Philosophically, Nancy believes that Reflexology affects the physical

body, emotions, mind and spirit of the person by working through the anatomical

and energy field systems of the body.”

Specific Demographic Information (based to those responding):

Education Status: High School: 12%

Some College: 25%

2 Year Degree: 16%

4 Year Degree: 26%

Advanced Degree: 22%

Location of Practice: Urban: 36%

Suburban: 43%

Rural: 21%

Years in Reflexology Practice: Average: 8 Years; 47% have practiced between 2 – 5 years.

Maintain currency through Continuing Education: 85%

Hours of initial training in Reflexology: 40% are classified in the “151 to 200 hour” range.

Number of hours training believed needed to develop a knowledgeable, competent, professional reflexologist: Mode: 200 hours (50 respondents); Median: 250 hours

Number of hours training believed needed to gain respect from professional educators, licensing agencies, the public, and other healthcare providers: Mode: 500 hours (48 respondents); Median: 350 hours

ARCB Certified: 84%

Location of the respondent’s sessions: 64% private practice in home

24% private clinic/office

3% holistic health center

3% hospital/nursing home

2% chiropractic office

Self-employed as a reflexologist: 88%

Full Time Practice: 29%; Part Time Practice: 71%

Client Sessions per week: Less than 10: 57%

11 – 20 31%

21 – 30 8%

31 – 40 3%

41 – 50 1%

Length of time per session: 62% “60 minutes”

18% “45 minutes”

14% “60+ minutes”

Reflexology as primary income source: 35% “Yes”; 65% “No”

Gender: Male: 11%; Female: 89%

Ethnicity: American Indian/Alaskan Native: 1%

Asian/Pacific Islander: 1%

African American: 2%

Caucasian: 95%

Hispanic: 1%

The Practice of Reflexology

The “Top 2” percentage ratings on the “practice” aspects of Reflexology: Session Techniques, Client Assessment and Reflexology Theory from the 2001 National Job Analysis Survey are presented in the table below. Equivalent items from the 1994 National Job Survey are included as points of comparison. Respondents answering “(3) Often use this technique/assessment/or would generally agree with this theory” have been combined with those answering “(4) Always use this technique/assessment/or strongly agree with this theory”.

Aspects of Reflexology Practice: 2001 – 1994 Comparative Summary	2001	1994
Session Techniques
Direct stationary pressure by thumb, finger to reflex areas	61%	54%
Even pressure with movement by thumb, finger to reflex areas	94%	95%
Circular pressure by thumb, finger to reflex areas	54%	54%
Use a light pressure	39%
Use a heavy pressure	51%
Use a moderate pressure	86%
Vary pressure within a session	94%
Use knuckles to apply pressure	18%	15%
Check with client regarding pressure preference	94%
Use tools during a session	4%	6%
Assess range of motion (e.g. joint motion, flexibility, active, passive, resistive, etc.)	86%	73%
Include fascia work (relaxing movements, tapping, cupping, stretching, light friction/stroking etc.)	77%	69%
Include joint mobilization	57%	51%
Work: Feet?	99%
Work: Hands?	58%
Work: Ears?	28%
Do you use any kind of lubricant before a session?	39%	19%
Do you use any kind of lubricant during a session?	27%	19%
Do you use any kind of lubricant at the end of a session?	47%	42%
Recommend a change in footwear	26%
Measure shoe size	6%
Recommend exercise	42%	53%
Provide nutritional information (vitamins, herbs, dietary guidelines, etc.)	27%	30%
Provide resources for lifestyle changes	38%	38%
Do you follow the medical model? (working for specific illnesses and working only those reflex areas)	21%	18%
Do you follow the stress reduction model? (working to relax the client)	91%	98%
Do you follow the energy model? (working to balance body energy)	83%	61%
Do you follow a combination? (of models)	78%
Do you always work both feet fully?	99%	96%
Provide psychological counseling?	12%	13%
Provide active listening?	94%	90%
Refer to other health care providers?	72%	71%
Apply adjunct therapies in a session?	39%	49%


Client Assessment
Take a client history before beginning the first session	94%	63%
Update client history periodically	80%	69%
Follow a set of guidelines for contraindications	84%	82%
Keep written chart notes on every client visit	82%	65%
Abide by a code of ethics	98%	99%
Make a visual assessment of feet	99%	99%
Make a biomechanical assessment of feet	63%	59%


	2001	1994
Reflexology Theory
Do you believe Reflexology works within zones?	88%	85%
Do you believe Reflexology works within the anatomical systems of the body?	92%	94%
Do you believe Reflexology works within the meridians?	88%	86%
Do you believe Reflexology works within the energy field/systems of the body?	90%	83%
Do you believe Reflexology works with the chakras?	67%
Do you believe Reflexology works with the aura?	63%
Do you believe Reflexology works within the electrical/chemical/magnetic systems of the body?	86%
Do you believe Reflexology works through placebo?	25%
Do you believe Reflexology works through touch?	97%
Do you believe Reflexology should include working on the feet?	99%	99%
Do you believe Reflexology should include working on the hands?	85%	97%
Do you believe Reflexology should include working on the ears?	53%	68%
Do you believe Reflexology should include working on the other micro-map areas found anywhere on the body?	36%	45%
Do you believe Reflexology should be applied with human touch only?	88%	83%
Do you believe Reflexology should be applied with tools only?	3%
Do you believe Reflexology has an effect on the physical body?	100%	100%
Do you believe Reflexology has an effect on the emotions?	99%	97%
Do you believe Reflexology has an effect on the mind?	98%	93%
Do you believe Reflexology has an effect on the spirit?	97%	87%
Do you believe the scope of practice of Reflexology involves the feet?	96%
Do you believe the scope of practice of Reflexology involves the feet and the ankles down?	96%	41%
Do you believe the scope of practice of Reflexology involves the feet, ankles and legs (I.e. from the knees down)?	61%	58%
Do you believe the scope of practice of Reflexology involves the hands?	92%
Do you believe the scope of practice of Reflexology involves the hands and the wrists down?	85%
Do you believe the scope of practice of Reflexology involves the hands, wrists and forearms (i.e. from the elbow down)?	57%
Do you believe the scope of practice of Reflexology involves the ears?	66%
Do you believe Reflexology is always safe?	70%	44%
Do you believe Reflexology has contraindications?	53%	68%
Do you believe in the theory: "No pain results in maximum gain"?	38%	57%
Do you believe in the theory: "No pain results in no gain"?	12%	12%

Comparisons of the techniques used within a session indicate increases in the use of stationary pressure by thumb, finger to reflex areas, range of motion assessments, fascia work (i.e., relaxation techniques) and the use of lubricants before a session. The use of lubricants shows the largest increase (20%), but is still not considered typical practice with only 39% reporting using lubricants prior to a session “always/often”. The use of stationary pressure is also not considered standard. Only 61% indicate using this technique.

A slight increase is noted in those following the “medical model” while they work. However, only 21% report doing so. The adherence to the “stress reduction model” dropped from 98% to 91%. It’s possible that this decrease is reflected in the increase observed in those who follow the “energy model” while they work. In 1994 only 61% reported following the “energy model” vs. 83% in 2001.

Within the Client Assessment aspect of practice, large increases are observed in taking a client history prior to the first session (31% increase to 94%), periodically updating the history (21% increase to 80%) and the practice of “charting” after every client’s session (17% increase to 82%). Guidelines for contraindications are still followed as standard practice (82% in 1994, 84% in 2001). Other standard practices still in place are abiding by a code of ethics (98%) visually assessing the feet (99%). The use of biomechanical assessment of the feet shows a slight increase, but not enough such that it is/would be considered common practice (59% in 1994, 63% in 2001).

Consistent with the large increase in ascription to the “energy model” is the increase observed in those who believe that Reflexology works within the energy field/systems of the body (83% in 1994, 90% in 2001). Common beliefs still held with respect to how Reflexology works are “within the anatomical systems of the body” (92%) and “within the meridians” (88%).

The main scope of practice for a reflexologist continues to be “the feet”. However a 55% increase is observed in those who believe the scope of practice involves “the feet and ankles down” (96%). Decreases are observed in the beliefs regarding working on the hands (down 12% to 85%) and the ears (down 15% to 53%). Although only 58% of the reflexologists responding report working on the hands, working on the hands is still considered common “practice” within the scope of Reflexology. Working on ears is not.

Aspects of Reflexology Practice: Importance Inferred

A method of inferring “importance” when ratings of importance are not obtained directly is the evaluation of the Means and Standard Deviations in concert with Top 2 usage/ascription percentage values. Larger Means coupled with small Standard Deviations, which indicate less variability in the respondents’ ratings, may be used to infer greater importance of that task, theory or belief associated with Reflexology practice. Likewise, smaller Mean Values coupled with larger Standard Deviations, (indicating greater variability in the respondents’ ratings) may be used to infer that the task, theory, or belief is of lesser importance with respect to Reflexology practice.

For the purpose of the current analysis, a task/practice, theory or belief with a Mean greater than “3” coupled with a Standard Deviation less than/equal to “1” is considered “important”. In addition, all the Top 2 usage/ascription percentages are greater than/equal to 80%. The table below incorporates all three values for each of the Session Techniques, Client Assessment practices and Reflexology Theory statements. Each area is in descending order by the Mean value.

Aspects of Reflexology Practice: 2001 Top 2%’s, Means and Standard Deviations

Session Techniques	Top 2	Mean	Std. Dev
Work: Feet?	99%	3.94	0.26
Do you always work both feet fully?	99%	3.84	0.39
Provide active listening?	94%	3.72	0.65
Check with client regarding pressure preference	94%	3.72	0.71
Vary pressure within a session	94%	3.68	0.72
Even pressure with movement by thumb, finger to reflex areas	94%	3.61	0.62
Do you follow the stress reduction model? (working to relax the client)	91%	3.58	0.79
Assess range of motion (e.g. joint motion, flexibility, active, passive, resistive, etc.)	86%	3.41	0.91
Do you follow the energy model? (working to balance body energy)	83%	3.24	1.08
Include fascia work (relaxing movements, tapping, cupping, stretching, light friction/stroking etc.)	77%	3.21	1.18
Use a moderate pressure	86%	3.13	0.74
Do you follow a combination? (of models)	78%	3.09