The effectiveness of non-pharmacological interventions in improving psychological outcomes for heart transplant recipients: a systematic review

Conway, Aaron, Schadewaldt, Verena, Clark, Robyn, Ski, Chantal, Thompson, David R., Kynoch, Kathryn and Doering, Lynn (2013) The effectiveness of non-pharmacological interventions in improving psychological outcomes for heart transplant recipients: a systematic review. The JBI Database of Systematic Reviews and Implementation Reports, 11 6: 112-132. doi:10.11124/jbisrir-2013-916

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Author Conway, Aaron
Schadewaldt, Verena
Clark, Robyn
Ski, Chantal
Thompson, David R.
Kynoch, Kathryn
Doering, Lynn
Title The effectiveness of non-pharmacological interventions in improving psychological outcomes for heart transplant recipients: a systematic review
Journal name The JBI Database of Systematic Reviews and Implementation Reports   Check publisher's open access policy
ISSN 2202-4433
Publication date 2013
Sub-type Critical review of research, literature review, critical commentary
DOI 10.11124/jbisrir-2013-916
Volume 11
Issue 6
Start page 112
End page 132
Total pages 21
Place of publication Adelaide, SA, Australia
Publisher Joanna Briggs Institute
Collection year 2014
Language eng
Formatted abstract
Background The International Society for Heart and Lung Transplantation recommended in 2006 that intervention studies to maximize psychological outcomes after transplantation should be conducted. Potentially, studies reporting on the effectiveness of non-pharmacological interventions in improving psychological outcomes for heart transplant recipients may have been published since the call for this research. Thus, further evidence may currently be available to inform policy and practice decision-making regarding the implementation of such interventions. Accordingly, an evaluation of the evidence is required.

Objectives The objective of this review was to identify the effectiveness of non-pharmacological interventions on psychological outcomes for heart transplant recipients.

Inclusion criteria
Types of participants This review considered studies that included community-living adults of all races and ethnicities who received a heart transplant (inclusive of multi-organ recipients such as heart and lung transplants).
Types of interventions This review considered studies that evaluated the effectiveness of any intervention that did not involve the administration of a medication. These may have been psychological interventions including, but not limited to, cognitive behaviour therapy, stress management and psychotherapy as well as other non-psychological interventions including, but not limited to, exercise and relaxation techniques.
Comparator: This review considered studies that evaluated the effectiveness of non-pharmacological interventions compared with no intervention, another variation of a non-pharmacological intervention, combination of non-pharmacological intervention and pharmacological intervention or pharmacological intervention.
Types of studies This review considered any experimental study design including randomized controlled trials, non-randomized controlled trials, quasi-experimental and before and after studies for inclusion.
Types of outcomes This review considered studies that included the following outcome measures:
• Clinical diagnosis of anxiety
• Clinical diagnosis of depression
• Anxiety symptoms as measured by a validated scale
• Depressive symptoms as measured by a validated scale
• Symptoms of stress as measured by a validated scale
• Mental health as measured by a validated quality of life scale.

Search strategy A comprehensive three-step search strategy was used to find published and unpublished English language studies with no time restrictions.

Methodological quality Retrieved papers were assessed by two independent reviewers prior to inclusion in the review using the standardized critical appraisal instrument from the Joanna Briggs Institute, Meta Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI).

Data collection Data was extracted from studies included in the review using the standardised data extraction tool from JBI-MAStARI.

Data synthesis As statistical pooling was not possible, the findings are presented in narrative form, including tables and figures.

Results Three studies fulfilled the inclusion criteria, which involved only 125 participants in total. Of the three included studies, two were randomized controlled trials and one was a quasi-experimental trial that incorporated a group of historical matched controls for comparison. Interventions included hospital-based and home-based exercise programs and an internet-based psychosocial intervention that incorporated stress and medical regimen workshops, monitored discussion groups, access to communication with the transplant team and information on transplant-related issues. Statistically significant improvements in anxiety and depressive symptoms and mental health scores were observed over time in intervention groups. However, between-group comparisons were not reported. Furthermore, the methodological quality of the studies was poor due to small sample sizes and baseline differences between control and intervention groups.

Conclusions There is insufficient high-quality evidence available to draw conclusions for or against the use of non-pharmacological interventions to improve psychological outcomes for adult heart transplant recipients. As such, further research is indicated.
Keyword Heart transplant
Anxiety
Depression
Stress
Quality of life
Systematic review
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Critical review of research, literature review, critical commentary
Collections: Official 2014 Collection
School of Nursing, Midwifery and Social Work Publications
 
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Created: Thu, 12 Sep 2013, 14:44:22 EST by Vicki Percival on behalf of School of Nursing, Midwifery and Social Work