Is progressive muscle relaxation (PMR) effective in improving quality of life, functional disability and positive symptoms among patients with acute schizophrenia?
Date of publication of the randomized controlled trial: March 2015
Design
Randomized controlled trial (RCT).
Participants
60 patients who diagnosed of schizophrenia according to the Diagnostic and Statistical Manual of Mental Disorders (fourth edition) and have no history of substance abuse or organic brain disease (age range: 18 to 67 years, male %: 56.7%). Patients who previously received schizophrenia-related education and/or relaxation training were excluded from the study.
Intervention
One 30-minute group education session was provided per week for 5 weeks, covering one topic each week in the following order: illness, treatment, well-being, support and patients’ rights. Ten 30-minute group PMR practice session was also provided over 5 weeks, two sessions per week. It included a general description of the purpose and rationale of relaxation and teaching the patients how to relax and contract 16 muscle groups.
Comparator
Comparison: Education plus PMR versus patient education according to usual ward procedures.
Major Outcomes
Outcome 1: Change in quality of life as assessed by the Quality of Life Enjoyment and Satisfaction Questionnaire Short Form (Q-LES-Q-SF) at the end of week 5. Higher marks indicate higher degree of enjoyment and satisfaction;
Outcome 2: Change in functional disability as assessed by the Sheehan Disability Scale (SDS) at the end of week 5. Higher marks indicate higher disability;
Outcome 3: Severity of positive schizophrenia symptoms as assessed by the Scale for the Assessment of Positive Symptoms (SAPS) at the end of week 5.
Settings
This study was performed in an outpatient setting.
Comparison    Education plus PMR versus patient education
Main Results
Compared to patient education, education plus PMR significantly improved the Q-LES-Q-SF score at week 5 (p<0.05). Besides, education plus PMR significantly reduced SDS (p<0.05) and SAPS scores at week 5 (p<0.05).
Comparison: Education plus PMR versus patient education in patients with acute schizophrenia
Outcomes No. of studies (Total number of participants) Mean change (SD) /No. of participants Heterogeneity test ( I2) MD (95% CI) p value Overall quality of evidence*
Intervention Comparator
1 1 (26) 17.9 (6.5)/13 1.8 (6.2)/13 Not applicable as there is only 1 study. Not reported <0.05 Low
2 1 (26) Work/ study: -2.6 (1.7)/13 Social life: -2.4 (1.6)/13 Family life/ home responsibilities: -2.3 (1.5)/13 Work/ study: 0 (1.9)/13 Social life: -0.1 (1.5)/13 Family life/ home responsibilities: 0 (1.5)/13 Not applicable as there is only 1 study. Not reported <0.05 <0.05 <0.05 Low
3 1 (26) -21.5(15.2)/13 -1.5(15.3)/13 Not applicable as there is only 1 study. Not reported <0.05 Low
Keys: SD = standard deviation; CI = confidence interval; MD = mean difference.
Comparison    Education plus PMR versus patient education
Main Results
Compared to patient education, education plus PMR significantly improved the Q-LES-Q-SF score at week 5 (p<0.05). Besides, education plus PMR significantly reduced SDS (p<0.05) and SAPS scores at week 5 (p<0.05).
Comparison: Education plus PMR versus patient education in patients with acute schizophrenia
Outcomes 1 2 3
No. of studies (Total number of participants) 1 (26) 1 (26) 1 (26)
Mean change (SD) /No. of participants Intervention 17.9 (6.5)/13 Work/ study: -2.6 (1.7)/13 Social life: -2.4 (1.6)/13 Family life/ home responsibilities: -2.3 (1.5)/13 -21.5(15.2)/13
Comparator 1.8 (6.2)/13 Work/ study: 0 (1.9)/13 Social life: -0.1 (1.5)/13 Family life/ home responsibilities: 0 (1.5)/13 -1.5(15.3)/13
MD (95% CI) Not reported Not reported Not reported
p value <0.05 <0.05 <0.05 <0.05 <0.05
Overall quality of evidence* Low Low Low
Keys: SD = standard deviation; CI = confidence interval; MD = mean difference.
Conclusion
Benefits
Compared to patient education, a combined intervention with education and PMR is more effective in improving quality of life, functional disability, and positive symptoms in patients with schizophrenia. 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
The authors did not mention adverse events of the intervention.
Link to Original Article
https://www.ncbi.nlm.nih.gov/pubmed/25671655
The synopsis is based on the following article:
Wang FZ, Luo D, Kanb W, Wang Y. Combined intervention with education and progressive muscle relaxation on quality of life, functional disability, and positive symptoms in patients with acute schizophrenia. J Altern Complement Med. 2015 Mar;21(3):159-65.


* 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.