Efficacy of nonpharmacologic interventions in preoperative anxiety: A systematic review of systematic reviews

Abstract

Aims and ObjectivesEvidence suggests that preparing patients for surgery using nonpharmacological strategies reduces their anxiety. However, there is no consensus on what the best practices are. This study aims to answer the question: Are interventions using nonpharmacological therapies effective in reducing preoperative anxiety?BackgroundPreoperative anxiety causes physiological and psychological adverse effects, with a negative effect on postoperative recovery.IntroductionAccording to the World Health Organization, between 266 and 360 million surgical procedures are performed annually worldwide, and it is estimated that more than 50% of patients will experience some degree of preoperative anxiety.DesignSystematic review of systematic reviews with results of interventions aimed at mitigating preoperative anxiety.MethodsA search was conducted for systematic reviews with meta‐analyses published between 2012 and 2021 in Medline, Scopus, Web of Science and Cochrane Library. Quality was assessed using the AMSTAR‐2 scale. The protocol was registered in PROSPERO.ResultsA total of 1016 studies were examined, of which 17 systematic reviews were selected, yielding 188 controlled trials with 16,884 participants. In adults, the most common intervention included music, followed by massage, in children virtual reality and clowns. Almost all controlled trials reported a reduction in preoperative anxiety after the intervention, of which almost half had statistically significant results.ConclusionInterventions that include music, massage and virtual reality reduce preoperative anxiety and have shown that they are cost‐effective, minimally invasive and with a low risk of adverse effects. Preoperative anxiety can be reduced through a short‐term intervention involving nursing professionals as an alternative or complement to drugs.Relevance to clinical practiceThis review suggests that nursing professionals, in collaboration with other health professionals, should continue to conduct research on the reduction in preoperative anxiety. Further research in this area is needed, to reduce heterogeneity and consolidate the results.No Patient or Public ContributionNot applied to our study, as it is a systematic review of systematic reviews.

Effectiveness of Virtual Reality on Postoperative Pain, Disability and Range of Movement after Knee Replacement: A Systematic Review and Meta-Analysis

“…Some research that also uses this measurement scale supports these results [ 28 ]. In addition, some studies even point out that VR could also be useful for the management of perioperative anxiety [ 29 , 30 ]. However, the quality of the evidence in these articles is rated as low or very low, and, therefore, more research is still necessary.…”

“…Virtual reality is expanding in clinical settings to support treatment and promote well-being [ 40 ]. At the treatment stage, it can be useful as a distraction method for pain management as a non-pharmacological treatment, to face uncomfortable medical procedures [ 41 ] and to reduce anxiety and the symptoms derived from it, since it enhances attention and helps the patient to feel more relaxed [ 30 ], thus promoting well-being and providing better quality care. Recent studies also demonstrate its usefulness in the field of rehabilitation [ 42 ].…”

Preoperative anxiety management in pediatric patients: a systemic review and meta-analysis of randomized controlled trials on the efficacy of distraction techniques

“…According to a study, when compared to the control group, the music group's postoperative patient satisfaction increased while the postoperative State-Trait Anxiety Inventory form 1 (STAI-1) score decreased after listening to their favorite music prior to elective inguinal hernia surgery, signifying its importance in anxiety controlling ( 64 ). Furthermore, In light of the conflicting findings in multiple studies about the impact of music therapy on blood pressure and heart rate, Agüero-Millan et al propose that patients should select the music they listen to in order to enhance these physiological parameters, urging the need for more confounding studies to be conducted on this distraction technique ( 65 ).…”

A bibliometric analysis of research on pediatric preoperative anxiety (2007–2022)

“…In addition, children are more likely to suffer from separation anxiety and maladaptive behaviors during the recovery phase of the postoperative period ( 2 ) and are thought to be associated with a higher incidence of delirium during the emergence phase ( 3 ). To mitigate a number of adverse effects of anxiety, previous researchers and clinical practitioners have explored a variety of methods to reduce preoperative anxiety, and there are two main categories of interventions to reduce preoperative anxiety: sedative medications and nonpharmacological interventions ( 4 ) (also known as psychobehavioral interventions). Among them, the use of preoperative sedative medication is considered a reliable strategy to reduce preoperative anxiety but has limitations in its application; first, many children experience adverse side effects such as nausea and vomiting ( 5 ).…”