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

Restless leg syndrome (RLS) affects 20-57% of hemodialysis patients, yet pharmacological options remain limited due to renal dysfunction. This network meta-analysis analyzed multiple non-pharmacological interventions for RLS management in hemodialysis patients.

This study systematically searched PubMed, Web of Science, and Cochrane databases for randomized controlled trials (RCTs) evaluating aromatherapy massage, reflexology, stretching, or combined interventions for RLS in hemodialysis patients. It measured RLS severity, the primary outcome, using the International RLS Study Group Rating Scale. Further, it performed frequentist network meta-analysis with standardized mean differences (SMD) and calculated surface under the cumulative ranking curve (SUCRA) scores. Evidence certainty was evaluated using the GRADE framework, and risk of bias was assessed using Cochrane RoB 2.0.

Eight RCTs (589 participants, 11 interventions) were included. Combined aromatherapy-reflexology ranked highest (SUCRA 92.3%, SMD vs. control: -3.54 [95% CI: -4.52, -2.55]), followed by stretching (SUCRA 87.4%, SMD: -3.29 [-4.07, -2.51]) and olive oil massage (SUCRA 78.0%, SMD: -3.01 [-4.02, -2.01]). The top ranking for combined aromatherapy-reflexology rests on a single trial (Ghasemi et al., 2021; n=35 per group) and an indirect network comparison, with GRADE certainty rated very low. All active interventions demonstrated significant superiority over control. Significant heterogeneity existed (I²=76-93%), and all studies showed a high risk of bias in outcome measurement.

Combined aromatherapy-reflexology ranked highest in the network meta-analysis, but this result rests on one small trial (n=35) and an indirect comparison, so it should be read as hypothesis-generating rather than confirmatory. All included trials were conducted in Iran, which limits how far the findings can be extrapolated to other settings. Future rigorously designed, adequately powered trials with blinded outcome assessment are especially needed to establish definitive treatment recommendations.