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

Abstract Aim Present review aimed to conduct a comprehensive review of the effectiveness of non-pharmacological interventions (NPIs) on reducing anxiety in adult burn patients. Method 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. Results 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. Conclusion 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.