NON-PHARMACOLOGICAL INTERVENTIONS FOR RESTLESS LEG SYNDROME IN HEMODIALYSIS PATIENTS: A SYSTEMATIC REVIEW AND NETWORK...

Area of Science:

• Nephrology
• Neurology
• Complementary Medicine

Background:

• Restless leg syndrome (RLS) affects a significant portion of hemodialysis patients (20-57%).
• Limited pharmacological treatments are available for RLS in this population due to renal dysfunction.
• Non-pharmacological interventions offer a potential alternative for RLS management.

Purpose of the Study:

• To conduct a network meta-analysis of non-pharmacological interventions for RLS in hemodialysis patients.
• To compare the efficacy of various interventions including aromatherapy massage, reflexology, and stretching.
• To identify the most effective intervention for RLS symptom reduction.

Main Methods:

• Systematic search of PubMed, Web of Science, and Cochrane databases for randomized controlled trials (RCTs).
• Inclusion of RCTs evaluating aromatherapy massage, reflexology, stretching, or combined interventions for RLS in hemodialysis patients.
• Network meta-analysis using standardized mean differences (SMD) and surface under the cumulative ranking curve (SUCRA) for ranking interventions.
• Assessment of evidence certainty using GRADE and risk of bias using Cochrane RoB 2.0.

Main Results:

• Eight RCTs involving 589 participants and 11 interventions were analyzed.
• Combined aromatherapy-reflexology showed the highest ranking (SUCRA 92.3%), followed by stretching (SUCRA 87.4%) and olive oil massage (SUCRA 78.0%).
• All active interventions were superior to control, but the top-ranked intervention was based on limited evidence (one small trial) with very low certainty and high risk of bias in outcome measurement.

Conclusions:

• Combined aromatherapy-reflexology emerged as the leading intervention in the network meta-analysis for RLS in hemodialysis patients.
• The findings are hypothesis-generating due to reliance on a single small trial and indirect comparisons, with very low GRADE certainty.
• Limitations include a high risk of bias in outcome measurement across studies and all trials being conducted in Iran, necessitating future rigorous, large-scale trials with blinded outcome assessment.