Are relaxation techniques effective for reducing stress and anxiety among parents with hospitalized premature infants?
Date of publication of the randomized controlled trial: February 2016
Design
Randomized controlled trial (RCT).
Participants
54 parents of infants <37 weeks of gestational age, who were admitted to the same neonatal intensive care unit (NICU) (mean age: 34.5 years in intervention group; 37.5 in control group, male %: 47.5%).
Intervention
Five 90-minute interactive training courses on positive thinking, healthy lifestyle, and self-knowledge were provided as intervention during the hospitalization period of infants, in addition to the daily medical parental briefing. Each session include 3 different relaxation techniques (deep breathing, progressive muscle relaxation, and guided imagery). Parents were encouraged to practice these techniques twice daily.
Comparator
Comparison: Information-based training courses plus relaxation techniques versus information-based training courses alone.
Major Outcomes
Outcome 1: Perceived stress as assessed by Perceived Stress Scale (PSS-14) at 3 months post-discharge. Higher scores indicated higher perceived stress levels.
Outcome 2: Anxiety as assessed by the State-Trait Anxiety Inventory (STAI) at 3 months post-discharge. Higher scores indicated higher anxiety levels.
Settings
This study was performed in an inpatient setting.
Comparison    Information-based training courses plus relaxation techniques versus information-based training courses alone
Main Results
Compared to information-based training courses alone, an addition of relaxation techniques showed significant reduction of trait anxiety as assessed by STAI at 3 months after discharge (p = 0.02). Addition of relaxation techniques also showed reduced levels of perceived stress as measured by PSS-14. However, the difference was not statistically significant (p = 0.699).
Comparison: Information-based training courses plus relaxation techniques versus information-based training courses alone in parents with hospitalized premature infants
Outcomes No. of studies (Total number of participants) Change in mean score (SD) /No. of participants Heterogeneity test (I2) MD (95% CI) p value Overall quality of evidence*
Intervention Comparator
1 1 (59) -3.3 (7.4)/31 -3.0(6.4)/28 Not applicable as there is only 1 study. Not reported 0.699 Low
2 1 (59) -4.2 (9.7)/31 2.6(9.3)/28 Not applicable as there is only 1 study. Not reported 0.020 Low
Keys: SD = standard deviation; MD = mean difference; CI = confidence interval.
Comparison    Information-based training courses plus relaxation techniques versus information-based training courses alone
Main Results
Compared to information-based training courses alone, an addition of relaxation techniques showed significant reduction of trait anxiety as assessed by STAI at 3 months after discharge (p = 0.02). Addition of relaxation techniques also showed reduced levels of perceived stress as measured by PSS-14. However, the difference was not statistically significant (p = 0.699).
Comparison: Information-based training courses plus relaxation techniques versus information-based training courses alone in parents with hospitalized premature infants
Outcomes 1 2
No. of studies (Total number of participants) 1 (59) 1 (59)
Change in mean score (SD) /No. of participants Intervention -3.3 (7.4)/31 -4.2 (9.7)/31
Comparator -3.0(6.4)/28 2.6(9.3)/28
MD (95% CI) Not reported Not reported
p value 0.699 0.020
Overall quality of evidence* Low Low
Keys: SD = standard deviation; MD = mean difference; CI = confidence interval.
Conclusion
Benefits
Compared to information-based training courses alone, an addition of relaxation techniques showed significant reduction in the parental trait of anxiety at 3 months post discharge. Relaxation techniques also resulted in reduced levels of stress at 3 months post discharge. For all outcomes, the overall quality of evidence is low. Further research is likely to have an important impact on our confidence in this estimate of effect.
Harms
No adverse events were specifically associated with relaxation intervention.
Link to Original Article
https://www.ncbi.nlm.nih.gov/pubmed/26520208
The synopsis is based on the following article:
Fotiou C, Vlastarakos PV, Bakoula C, Papagaroufalis K, Bakoyannis G, Darviri C, Chrousos G. Parental stress management using relaxation techniques in a neonatal intensive care unit: A randomised controlled trial. Intensive and Critical Care Nursing, 2016 Feb;32, 20-28.


* Interpretation of quality assessment results:
• Very low: Further research is most likely to have an important impact on our confidence in this estimate of effect.
• Low: Further research is likely to have an important impact on our confidence in this estimate of effect.
• Moderate: Further research is fairly likely to have an important impact on our confidence in this estimate of effect.
• High: Further research is unlikely to have an important impact on our confidence in this estimate of effect.
• Very high: Further research is most unlikely to have an important impact on our confidence in this estimate of effect.

Details of assessment method can be found at Chung VC, Wu XY, Ziea ET, Ng BF, Wong SY, Wu JC. Assessing internal validity of clinical evidence on effectiveness of CHinese and integrative medicine: Proposed framework for a CHinese and Integrative Medicine Evidence RAting System (CHIMERAS). European Journal of Integrative Medicine. 2015 Aug 31;7(4):332-41.