Non-Pharmacological Interventions Before Cataract Surgery for Preoperative Anxiety: A Systematic Review and Meta-Analysis.
Mahsan Nabighadim, Mojgan Mirghafourvand, Mahsa Maghalian
PMID 39846083WHAT IT FOUND
Non-drug interventions before cataract surgery lowered anxiety, but the evidence was very low certainty and highly inconsistent.
Do not treat any single technique as proven.
Key findings
01The meta-analysis of 22 studies and 1998 participants found a significant reduction in preoperative anxiety with non-pharmacological interventions compared with controls (SMD -2.14, 95% CI -3.48 to -0.79; p < 0.001).
02The overall evidence was very low certainty because of high heterogeneity (I² = 99.4%), risk of bias and suspected publication bias.
03Music showed a significant reduction with low-certainty evidence (SMD -1.26, 95% CI -1.70 to -0.80; 5 trials, 584 participants), while foot massage was not statistically significant (SMD -5.12, 95% CI -11.7 to 1.46; 2 trials, 120 participants).
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The overall result had very high heterogeneity (I² = 99.4%), so the pooled effect may not represent any single clinical setting. GRADE rated the evidence for preoperative anxiety as very low certainty, and the authors said they could only make a weak recommendation. Publication bias was suspected: the funnel plot was asymmetric, the Egger test was p = 0.006, and Trim-and-Fill suggested 7 missed studies. Six included studies were quasi-experimental and had serious overall risk of bias by ROBINS-I. Blinding was often impossible or incomplete, especially for massage, video, education and aromatherapy, which can affect self-reported anxiety. The review included only English-language controlled and quasi-experimental trials, so relevant non-English studies may be missing. Studies used different anxiety scales and varied intervention details, making direct comparison difficult. Many studies had small sample sizes, and some subgroup confidence intervals were very wide.
Declared interests
The authors declared no conflicts of interest.
The easy way to misread this
Do not read the pooled reduction as proof that any non-drug intervention works for your cataract patients. The overall evidence was very low certainty, heterogeneity was I² = 99.4%, publication bias was suspected, and the authors could only make a weak recommendation.