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Research Article

Effectiveness of Hot Water Footbath Therapy in Reducing Body

Temperature amongst Patients with Fever
Muthupriya M1, R. Lakshmi1
1
Assistant professor, Hindu Mission College of Nursing, Chennai, Tamil Nadu, India

Abstract
Fever has been recognised as a symptom and not a disease in itself. The thermoregulatory centre in the hypothalamus regulates body
temperature. Hydrotherapy in the form of cold and tepid applications has been historically used for reducing increased body temperature.
Many studies have looked at effect of hydrotherapy over pharmacological measures and have found that tepid or cold sponging reduces body
temperature rapidly, but are associated with discomfort for the patients. There is some evidence that hot water soaks to foot reduces body
temperature effectively. Hot water footbath is considered as a non‑pharmacological, safe, side effect‑free, cost‑effective and easy‑to‑administer
therapy to reduce fever. The aim of this study was to assess the effectiveness of hot water footbath therapy (HWFBT) in reducing the body
temperature in adult patients with fever. Sixty patients were selected by convenient sampling technique, of which thirty patients were allotted
to experimental group and thirty to control group by random method. HWFBT was given to experimental group. The control group received
the standard care as per practice of the hospital. The findings showed that the difference in the mean body temperature in the post‑test was
significantly lower in the experimental group (P < 0.001). HWFBT may, therefore, be effectively used as an intervention to reduce the body
temperature in patients with fever.

Keywords: Adults, fever, hot water footbath therapy

Introduction these interventions may cause shivering, which is a discomfort

Fever has been recognised as a symptom and not a disease.
Fever is a natural response of the body that helps in fighting
foreign substances such as microorganisms. Thermoregulatory
centre in the hypothalamus regulates body temperature. Once
the temperature rises, the person often feels warm, the cellular
metabolism increases, oxygen consumption rises and heart
and respiratory rate increases to meet the metabolic needs of
the body. Increased metabolism uses energy that produces
additional heat.
Hydrotherapy is the use of water at any temperature or in
any form in the treatment of disease. Hydrotherapy is based
on the theory that water with its cooling, warming and/or
cleansing properties has healing effects.[1] Warm water therapy,
particularly, is a traditional method of treatment that has been
used for the treatment of disease and injury in many cultures.
Some of the non‑pharmacological measures such as tepid
sponging and cold sponging are found to be effective in
reducing fever. However, the rapid cooling that occurs with
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to the patients. Randomised control trials comparing cold or
tepid sponging versus oral antipyretics in groups of febrile
children have shown that the hydrotherapy measures are
effective in rapid reduction of temperature in the first 30 min to
1 h of application versus a gradual reduction of fever with oral
antipyretics, effects of both being similar at 2–3 h. Sponging
was associated with gross discomfort for children.[2]
Another measure, which has been tried in reducing fever,
mainly children, is the hot water footbath. Hot water footbath
therapy  (HWFBT), one of the hydrotherapeutic measures,
improves peripheral blood circulation and provides warmth
and comfort for the patients.[3] HWFBT is said to improve
Address for correspondence: Mrs. Muthupriya M,
Hindu Mission College of Nursing, Tambaram, Chennai, Tamil Nadu, India.
E‑mail: mpmuthupriya@gmail.com
Submitted: 15-Mar-2018 Revised: 18-Nov-2019
Accepted: 08-Jan-2020 Published: 19-Feb-2021
This is an open access journal, and articles are distributed under the terms of the Creative
Commons Attribution‑NonCommercial‑ShareAlike 4.0 License, which allows others to
remix, tweak, and build upon the work non‑commercially, as long as appropriate credit
is given and the new creations are licensed under the identical terms.
For reprints contact: WKHLRPMedknow_reprints@wolterskluwer.com

DOI: How to cite this article: Muthupriya M, Lakshmi R. Effectiveness of hot

10.4103/IJCN.IJCN_19_20 water footbath therapy in reducing body temperature amongst patients with
fever. Indian J Cont Nsg Edn 2020;21:181-4.

© 2021 Indian Journal of Continuing Nursing Education | Published by Wolters Kluwer - Medknow 181
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Muthupriya and Lakshmi: Hot water footbath therapy in reducing body temperature
immune response which helps in counteracting the underlying
infection which causes the fever.[4] As in cold or tepid sponging,
rapid cooling is not brought about in HWFBT. Temperature is
brought down gradually, so that it allows slow heat loss, thus
avoiding rapid cooling and shivering.
The temperature regulatory centre in the hypothalamus
has both heating and cooling capabilities. When the body
temperature rises above the set point (normal temperature),
the temperature‑regulating centre attempts to loose heat by
increasing the blood flow to the skin and by sweating. When
body temperature falls below normal, the physiological
reaction of shivering and peripheral vasoconstriction is
initiated to increase heat production and reduce heat loss.
Hot water footbath is based on this physiology of heat
loss.[5] It is a procedure that involves immersing the feet
and ankles in hot water at temperature ranging from 39°C
to 43°C  (102°F to 109°F).[4] The temperature of the water
is adjusted to the tolerance of the patients. HWFBT works
by initiating skin vasodilatation and inducing sweat through
increasing peripheral temperatures. Skin vasodilatation results
in small amounts of dry heat loss and is primarily responsible
for internal heat transfer, that is, transferring the heat from
core (internal organs) to the skin. The sweating causes heat
loss and cooling through evaporation  (external heat loss).
The peripheral blood is cooled before it returns to the internal
deeper tissues and organs.[6] Previous studies done in febrile
children have shown that HWFBT is beneficial when fever is
between 38°C and 39°C (100°F to 102° F). This study was done
with an aim to apply hot water footbath in adults with fever.
Objectives
1. To evaluate the difference in the body temperature
between pre‑ and post‑assessments in the experimental
group who had hot water footbath and controls who had
standard care.
2. To evaluate the effectiveness of hot water footbath on
body temperature in experimental group of patients as
compared to those patients who had standard care.
Hypothesis
H 1  ‑  There will be a significant difference in the body
temperature in experimental group and control group after
HWFBT as compared to the control group who had standard
care at 0.05 level of significance.
Methodology
A quantitative approach with an experimental design was
used to assess the effectiveness of HWFBT for reducing the
body temperature amongst patients with fever. The study
was conducted at the medical ward of a tertiary hospital in
Chennai. Conscious patients suffering from fever between
20 and 60  years, including both male and female patients
with temperature 100°F–103°F, were included in the study.
Patients who had peripheral vascular disorders or peripheral
neuropathy or with ulcers or lesions in the legs were excluded
from the study. Sixty patients who fulfilled the criteria were
182 Indian Journal of Continuing Nursing Education  ¦  Volume 21  ¦  Issue 2  ¦  July-December 2020
selected and randomly allocated to experimental and control
groups (30 in each group).
A data profile sheet that included items such as age and gender,
body temperature of the patient before and after intervention,
duration of fever and associated illness was used as the tool.
Axillary temperature was measured using a standard digital
thermometer for all study patients. The content of the tool
was reviewed and refined by subject experts. After pilot study,
reliability of the tool was assessed using inter‑rater method and
its correlation coefficient (r) value was 0.88. Only footbath
was administered to the experimental group. For patients with
temperatures ranging from 100° to 103°F, HWFBT was given
for 15–20 min duration. For the participants in control group,
hospital routine (antipyretics with or without tepid sponging)
was carried out. Temperature was checked after 15–20 min
of intervention. Approval for the study was obtained from the
Institutional Ethical Committee and Head of the Department.
Written informed consent was obtained from each study
participant after giving full information about the study.
Anonymity was assured to each participant and maintained
by the researcher.
Results
In the experimental group, there were equal numbers of
male and female patients. The control group consisted
majority of males  (66.7%). Majority of the participants in
both experimental  (63.3%) and control  (50%) groups were
between 20 and 30  years of age. About 60% of those in
experimental group and 56.7% in the control group had fever
of 101°F–102.9°F. The duration of fever was found to be 2 days
in 43.3% and 40% of them in experimental and control groups,
respectively. However, more number of patients (13, 43.3%)
had fever for 1 week in experimental group compared to only
8 (26.7%) in the control group [Table 1].
Paired t‑test revealed that both experimental and control
groups showed a significant reduction in body temperature in
the post‑assessment. Both hot water foot therapy and standard
care were effective in reducing the body temperature in fever
patients [Table 2].
In the pre‑test, participants in the experimental group were
having a mean temperature of 101.45°F, whereas in control
group, it was 101.33°F. The mean difference in temperature
before intervention was not statistically different between
control and experimental groups.
In the post‑assessment, the mean temperature of experimental
and control group participants was 99.83°F and 100.8°F,
respectively. The mean difference in the temperature was found
to be 0.94°F. The difference between experimental and control
groups in the post‑assessment was found to be statistically
significant  (P  <  0.001)  [Table  3]. Hence, it is evident that
HWFBT was more effective in reducing the body temperature
at specific post‑assessment time period when compared to the
standard fever care.
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Muthupriya and Lakshmi: Hot water footbath therapy in reducing body temperature

Discussion and/or cold/tepid sponging for controlling fever has been the
general measures to control fever in both adults and children
The present study evaluated the effectiveness of hot water in hospital as well as at home,[7‑9] and the effectiveness of these
footbath in reducing the body temperature in adults with measures has been reinforced in this study.
fever when compared to routine measures for fever reduction.
Majority of the study participants in both groups were between Use of alternative methods such as hot water footbath for
20 and 30 years of age. The study findings indicate that both reducing fever has been studied infrequently. In this study, the
experimental group of participants was given only hot water
experimental and control group participants had a significant
footbath without any other measures for fever reduction. The
reduction in body temperature. The hospital procedure of
results showed that there was a significant reduction of body
administering antipyretics and tepid sponging if accepted by temperature in the experimental group and further showed a
patients were the routine measures that were followed for higher reduction in body temperature when compared to the
control group participants. The study findings reveal that these control group in the post‑assessment. The above findings reveal
measures were effective in controlling body temperature in the that hot water footbath was more effective in reducing the body
control group by showing statistically significant reduction temperature in adult patients with fever. Similar results have
in body temperature at post‑assessment. Use of antipyretics been found in other studies. A qualitative study from Iran found
that mothers of children used footbath for controlling fever
and found that tepid water footbath was effective in reducing
Table  1: Demographic and clinical profile of participants
the body temperature.[8] Hot water foot therapy was effective
with fever
in children with fever, and the cooperation to procedure was
Frequency (%) much better to hot water foot therapy.[10] Another study from
Experimental Control India found that there was a significant reduction in the body
Age (years) temperature in adult patients with fever who had hot water foot
20‑30 19 (63.3) 15 (50.0) immersion therapy in addition to standard care compared to
31‑40 2 (6.7) 6 (20.0) the control group. Patients were highly satisfied in hot water
41‑50 4 (13.3) 5 (16.7) immersion group and the therapy was useful in all types of
51‑60 5 (16.7) 4 (13.3) fever.[9] Satisfaction of patients was not measured in this study.
Gender Majority of the patients in this study had fever for longer
Male 15 (50.0) 20 (66.7) duration (2 days to 2 weeks). Although the association was
Female 15 (50.0) 10 (33.3) not known, it is evident that hot water footbath was beneficial
Body temperature (°F) even for those with long‑term fever. Warming also reduces
100‑100.9 6 (20.0) 8 (26.7) shivering which is an added advantage and comfort for patients.
101‑101.9 9 (30.0) 8 (26.7)
Therefore, hot water footbath can be effectively used in care
102‑102.9 9 (30.0) 9 (30.0)
of patients with fever.
103 6 (20.0) 5 (16.7)
Duration of fever
Since last night 2 (6.7) 4 (13.3) Conclusion
Past 1 day 2 (6.7) 6 (20.0) HWFBT is a simple therapeutic modality which can be carried
Past 2 days 13 (43.3) 12 (40.0) out in a hospital setting or by the patient themselves in their
Past 1 week 13 (43.3) 8 (26.7) homes. It is economical. The efficiency of HWFBT on reduction

Table  2: Comparison of pre and post of mean body temperature in experimental and control groups
Number of Mean±SD Paired t‑test
subjects
Preassessment Postassessment
Experiment 30 101.45±1.07 99.83±0.83 t=10.24, P=0.001***
Control 30 101.33±1.06 100.80±1.00 t=4.00, P=0.001***
***Significant at P≤0.001. SD: Standard deviation

Table  3: Comparison of mean body temperature between experimental and control groups in pre‑  and post‑test
Number of Mean±SD Statistical P
patients value (t)
Experiment Control
Pre‑test 30 101.45±1.07 101.33±1.06 0.41 0.68
Post‑test 30 99.83±0.83 100.80±1.00 3.96 0.001***
***P≤0.001. SD: Standard deviation

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Muthupriya and Lakshmi: Hot water footbath therapy in reducing body temperature

of body temperature found in this study augments other study
findings and offers an insight in decision‑making process for
appropriate intervention. Since this is a non‑pharmacological
treatment, it is recommended at the right time with prompt
duration for fever patients.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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184 Indian Journal of Continuing Nursing Education  ¦  Volume 21  ¦  Issue 2  ¦  July-December 2020