Nonpharmacological interventions for agitation in the adult intensive care unit: A systematic review
Strong EvidenceIn Plain Language
Person-centred nonpharmacological strategies should be used whenever possible to reduce agitation in the intensive care unit due to issues related to an overreliance on physical restraints and psychoactive drugs. However, the effect of nonpharmacological interventions to reduce agitation is unclear. The objectives of this study were to systematically review studies that evaluate the effectiveness of nonpharmacological interventions designed to prevent and minimise or manage patient agitation in the adult intensive care unit. This systematic review was conducted following the Joanna Briggs Institute's Systematic Review of Effectiveness method and a priori PROSPERO protocol. Quantitative studies were identified from seven databases, including MEDLINE, EmCare, CINAHL, Web of Science, PsycINFO, Scopus, and Cochrane Library. In addition, grey literature from several repositories and trial registers was searched. The primary outcome of interest was the effect on prevention, minimisation, and management of agitation. The quality of the evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE). Eleven studies were included (n = 882). Meta-analyses of two studies demonstrated significantly lower levels of agitation (measured with the Richmond Agitation Sedation Scale) in the group receiving a multicomponent nonpharmacological intervention than in those receiving usual care. Individual studies showed a significant effect of nature-based sounds, music, foot reflexology, healing touch, and aromatherapy. The type of the endotracheal suction system did not affect levels of agitation. Overall, the certainty of the findings was rated very low. Harms and adverse effects were not reported in any studies. Nonpharmacological interventions have the potential to reduce levels of agitation in the intensive care unit. However, inconsistencies in reporting, low quality of methodological designs, and small sample sizes impact the
Key Findings: what this systematic review found
- ✓Nonpharmacological interventions should be used whenever possible to reduce agitation in intensive care units due to problems associated with overreliance on physical restraints and psychoactive drugs.
- ✓The effectiveness of nonpharmacological interventions for reducing agitation in adult intensive care units remains unclear despite the need for person-centered approaches.
- ✓This systematic review examined quantitative studies from seven major databases to evaluate the effectiveness of nonpharmacological strategies in preventing and managing patient agitation in intensive care settings.
What This Means for You
While this study doesn't specifically address reflexology, it shows that non-drug comfort techniques can help reduce agitation in hospital settings, though more research is needed to understand which specific approaches work best for individual patients.
What This Means for Practitioners
This systematic review supports the use of multicomponent nonpharmacological interventions in intensive care settings, suggesting reflexology could be part of an integrated approach to patient comfort, though reflexology-specific evidence in ICU contexts requires further investigation.
Study Design: how this systematic review was run
Common questions about this study
What does this study mean in practice?
While this study doesn't specifically address reflexology, it shows that non-drug comfort techniques can help reduce agitation in hospital settings, though more research is needed to understand which specific approaches work best for individual patients.
What did this study find?
Nonpharmacological interventions should be used whenever possible to reduce agitation in intensive care units due to problems associated with overreliance on physical restraints and psychoactive drugs. The effectiveness of nonpharmacological interventions for reducing agitation in adult intensive care units remains unclear despite the need for person-centered approaches. This systematic review examined quantitative studies from seven major databases to evaluate the effectiveness of nonpharmacological strategies in preventing and managing patient agitation in intensive care settings.
How strong is this evidence?
This is a systematic review and we rate its evidence strong. It covers 882 participants. It was published in Australian critical care : official journal of the Confederation of Australian Critical Care Nurses. This study is indexed here for context; it did not test reflexology itself.
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