Non-pharmacological interventions for anxiety in burn patients: A systematic review and meta-analysis of randomized controlled trials

• Published in: Complementary therapies in medicine 2020-03, Vol.49, p.102341-102341, Article 102341
• Main Authors: Fardin, Ajoudani, Rezaei, Soheila Ahangarzadeh, Maslakpak, Masumeh Hemmati
• Format: Article
• Language: English
• Subjects: Alternative medicine; Anxiety; Aromatherapy; Bias; Burn; Burn patients; Clinical trials; Computer applications; Confidence intervals; Direct current; Electrical stimulation of the brain; ESB; Heterogeneity; Hypnosis; Intervention; Meta-analysis; Music; Non-pharmacological interventions; Pain; Pain anxiety; Patients; Pharmacology; Randomization; Systematic review; Virtual reality
• ISSN: 0965-2299; 1873-6963
• DOI: 10.1016/j.ctim.2020.102341

•Non-pharmacological interventions have a varying efficacy on anxiety in burn patients.•A considerable heterogeneity is observed among studies.•Weak recommendations in favor of NPIs for burn anxiety can be made now.•Further well-designed large sample size randomized clinical trials are warranted. Present review aimed to conduct a comprehensive review of the effectiveness of non-pharmacological interventions (NPIs) on reducing anxiety in adult burn patients. We searched PubMed, Web of Science, Scopus, Cochrane Library, and Google Scholar databases through September 2019 for randomized clinical trials comparing NPIs to a control group. The primary outcomes were general anxiety and pain anxiety. The Cochrane Risk of Bias Tool was used to assess the risk of bias. All data was pooled with Revman 5.3. 20 studies were eligible for quantitative synthesis. Compared to routine care, Music (4 Randomized Clinical Trials (RCTs), Standardized Mean Difference (SMD) = –2.00, 95 % Confidence Interval (CI) = –3.21 to –0.79), massage (4 RCTs, SMD= –1.84, 95 % CI= –2.77 to –0.91), hypnosis (2 RCTs, SMD= −1.06, 95 % CI= −2.90 to 0.78), relaxation (2 RCTs, SMD= −0.77, 95 %CI= −1.52 to −0.02), transcranial direct current stimulation (1 RCT, SMD= −1.92, 95 %CI= −2.54 to −1.30), and therapeutic touch practices (1 RCT, SMD=−0.45 95 %CI= −0.86 to −0.04), were associated with a significant effect on the anxiety of burn patients. Aromatherapy interventions and virtual reality showed no evidence of a reduction in the anxiety. A large amount of heterogeneity exist among trials. Risk of bias varied across studies. Only one study reported on safety issues. Due to weak evidence, we are unable to make strong recommendations in favor of NPIs for burn anxiety. Further well-designed large sample size randomized clinical trials are warranted.