A Systematic Review and Meta-Analysis of Footbath Effects and Optimal Procedures to Improve Sleep in Older Adults

Sleep disturbances are prevalent among older adults and are linked to adverse health outcomes. While warm footbaths are widely practised as a non-pharmacological intervention, their effectiveness and optimal parameters remain uncertain. This systematic review and meta-analysis aimed to evaluate the effects of footbaths on sleep quality and determine evidence-based procedural recommendations.

Nine databases were systematically searched up to November 2023. Study quality was assessed using the Joanna Briggs Institute tools, and certainty of evidence was graded via the Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Meta-analyses were conducted using random-effects models.

A total of 18 studies involving 950 older adults (aged ≥ 60 years; 52.3% female) were included. Warm footbaths significantly improved subjective sleep quality compared with non-footbath controls (SMD = -0.76; 95% CI: [-1.22, -0.29]; p = 0.001). Optimal effects were observed with water temperatures ≤ 40°C (SMD = -1.31; 95% CI: [-1.63, -0.99]; p < 0.001), immersion times ≥ 10 min (SMD = -0.96; 95% CI: [-1.36, -0.57]; p < 0.001) and intervention periods of at least one week (SMD = -1.06; 95% CI: [-1.64, -0.48]; p = 0.0003), which showed significant sleep quality improvements.

Warm footbaths before bedtime may enhance perceived sleep quality in older adults, offering a simple, culturally adaptable intervention. Standardised protocols could strengthen their role in sleep hygiene practices. Future large-scale, multicentre trials integrating subjective and objective assessments are warranted to confirm efficacy and explore cross-cultural applicability.

International Platform of Registered Systematic Review and Meta-analysis Protocols (INPLASY): INPLASY202290025.