EFFECTIVENESS OF RELAXATION THERAPIES IN REDUCING ANXIETY AND DEPRESSION IN PATIENTS WITH CHRONIC KIDNEY DISEASE UNDERGOING HAEMODIALYSIS: A SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMISED CONTROLLED TRIALS.

Abstract

Background: The prevalence of patients diagnosed with chronic kidney disease is on the rise. Many of these patients experience anxiety and depression as they try to cope with the disease. Relaxation therapies had shown to be effective at relaxing the mind and bodies of patients, thus promoting psychological well-being. Objectives: This systematic review and meta-analysis aimed to examine the effectiveness of relaxation therapies in reducing anxiety and depression in patients with chronic kidney disease undergoing haemodialysis. Methods: A systematic search through seven databases (CINAHL, EMBASE, PubMed, Cochrane, PsycINFO, Web of Science and Scopus) was performed from commencement till 15 December 2019. Quality of evidence was evaluated using GRADE and The Cochrane Risk of Bias tool. Review Manager software was used to conduct meta-analysis. The DerSimonian and Laird random-effects model was used with Inverse-Variance method to obtain the Standardised Mean Differences with 95% Confidence Intervals. I² statistic and Cochran’s Q (?² test) were used to assess heterogeneity. Overall effect was evaluated using effect size and Z-statistics. Funnel plot was utilised to assess Publication bias. Results: A total of 14673 studies were found. This review included fifteen randomised controlled trials (sixteen articles). Meta-analysis revealed small to medium effect size favouring relaxation therapies in reducing anxiety and depression in patients undergoing haemodialysis. Subgroup analysis suggested no differences between types of relaxation therapies, intervention duration and number of sessions. Overall quality of evidence graded using GRADE was very low for both outcomes. Conclusion and Implications: Relaxation therapies appear to reduce anxiety and depression in patients undergoing haemodialysis to a certain extent. More high-quality studies with large sample size are needed to support the effectiveness of such interventions. Healthcare professionals can consider such complementary interventions to improve mental health of patients undergoing haemodialysis and reduce pharmacological complications.