Nonpharmacological Interventions to Reduce Anxiety in Paediatric Preoperative Settings: An Updated Umbrella Review and Meta-Analysis

Abstract

Purpose

The aim of this study was to identify nonpharmacological therapies to reduce anxiety in children and adolescents undergoing surgery, and their parents/caregivers.

Methods

Using keywords derived from Medical Subject Headings, we conducted a comprehensive search of articles published in the last 5 years in the Web of Science, Scopus, PubMed, COCHRANE and CINHAL databases, supplemented by a reverse search. We conducted a meta-analysis by re-analysing the primary data from the included studies and we assessed the quality of the articles using the AMSTAR-2 criteria.

Results

According to the meta-analytic results obtained for each type of intervention, all generally indicate a positive effect for both children/adolescents and parents/caregivers. For children, the intervention type that stands out the most is digital health interventions, with the maximum positive effect in video tape (−1.84 [−2.76 to −0.91]), followed by video glasses (−1.47 [−2.32 to −0.63]), and video games (−1.61 [−2.59 to −0.63]). The effect of this type of intervention is smaller for parents/caregivers, being only significant in the case of Web/App interventions (−0.52 [−0.77 to −0.27]). Although with a smaller effect size, other health interventions also demonstrate a positive effect for both groups. For children/adolescents, interventions such as traditional game therapy (−0.80 [−1.24 to −0.37]), music therapy (−0.57 [−1.03 to −0.10]), parental/caregiver presence (−0.53 [−0.79 to −0.27]), and clown therapy (−0.52 [−0.75 to −0.29]) are particularly notable. For parents/caregivers, both traditional game therapy (−0.34 [−0.54 to −0.14]) and parental/caregiver presence (−0.28 [−0.53 to −0.03]) appear to have a positive effect, though less pronounced than in children/adolescents. Finally, multifaceted interventions show significant results only for children/adolescents (−0.45 [−0.70 to −0.20]), although with a smaller effect size compared to other treatments.

Conclusions and Practice Implications

This study highlights the importance of using nonpharmacological therapies to manage preoperative anxiety in the paediatric population. In particular, digital and other health interventions have been shown to be effective across a range of surgical specialities. However, further research is needed, particularly in relation to guided imagery, Benson's breathing and hypnotherapy, where the evidence is scarce. Nurses need to be proficient in the use of these interventions. It is therefore essential that health policymakers allocate resources and support to help integrate these therapies into treatment protocols and clinical guidelines.