Department of Psychology, University of Detroit Mercy, Detroit, MI, USA.
Libraries/IDS, University of Detroit Mercy, Detroit, MI, USA.
J Altern Complement Med. 2021 Sep;27(9):717-726. doi: 10.1089/acm.2020.0504. Epub 2021 Jun 1.
State (situational) anxiety can create suboptimal outcomes for patients across a variety of health care specializations. While anxiolytic medications reduce anxiety, problematic side effects can compromise outcomes. These challenges have spurred searches for nonpharmaceutical approaches to alleviate patient anxiety. This systematic literature review, largely following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, aimed to determine patterns and effectiveness of interventions across medical health care specialty areas, including dentistry. A systematic review was conducted, using PubMed, CINAHL, and PsycINFO databases, with search terms related to anxiety, specific interventions, and medical or dental procedures. Hand searching for additional citations was performed on the bibliographies of dissertations, meta-analyses, and systematic reviews that met article inclusion criteria. The search process yielded 48,324 articles and 257 dissertations published in English between 1974 and 2018. Each abstract was evaluated for inclusion by two reviewers, yielding 718 articles that were read and evaluated for outcomes, risk of bias, pretest and post-test, controls and quality, using a Critical Appraisal Skills Programme instrument. Of these, 408 articles, describing 501 experimental trials, were accepted for inclusion in this analysis. A total of 50,343 patients were included in these experiments, with an overall success rate of 71% for reducing patient anxiety. Results are summarized by health care specialty area: surgery, oncology, cardiology, obstetrics/gynecology, dentistry, and pain/trauma, and the following diagnostic testing and intervention areas: imaging, colonoscopy, mechanical ventilation, and other. The largest number of experiments (114) was in the surgery category. The types of interventions included , , , , , , , , , , , , , and . The largest numbers of experiments were done with (143) and (130). The following interventions were most successful, reducing anxiety in over 70% of experiments: , , , , , , Confidence in results is limited by publication bias, small sample sizes, and the lack of placebo controls. Directions for future research are discussed.
状态（情境）焦虑会影响各种医疗专业的患者的治疗效果。抗焦虑药物虽然可以降低焦虑程度，但可能会产生不良的副作用，从而影响治疗效果。这些挑战促使人们寻找非药物方法来缓解患者的焦虑。本系统文献综述主要遵循系统评价和荟萃分析报告的首选条目，旨在确定医疗保健专业领域（包括牙科）的干预措施的模式和效果。使用 PubMed、CINAHL 和 PsycINFO 数据库进行系统检索，检索词涉及焦虑、特定干预措施以及医疗或牙科程序。对符合文章纳入标准的论文、荟萃分析和系统综述的参考文献进行了额外的手工检索。检索过程共产生了 1974 年至 2018 年间发表的 48324 篇文章和 257 篇论文。两位评审员对每篇摘要进行了评估，确定了 718 篇文章进行阅读和评估，使用关键评估技能计划工具评估结果、偏倚风险、前测和后测、对照和质量。其中，有 408 篇文章，描述了 501 项实验性试验，被接受纳入本分析。这些实验共纳入了 50343 名患者，总体降低患者焦虑的成功率为 71%。结果按医疗保健专业领域进行总结：外科、肿瘤学、心脏病学、妇产科、牙科和疼痛/创伤，以及以下诊断测试和干预领域：影像学、结肠镜检查、机械通气和其他。外科领域的实验数量最多（114 项）。干预措施的类型包括：教育、放松训练、音乐、针灸、冥想、催眠、药物、预先告知、生物反馈、社会支持和手术前访视。实验数量最多的是（143 项）和（130 项）。以下干预措施最成功，超过 70%的实验中降低了焦虑：认知行为疗法、预先告知、放松训练、音乐、针灸、生物反馈、社会支持。结果的可信度受到发表偏倚、样本量小和缺乏安慰剂对照的限制。讨论了未来研究的方向。
