Effect of aromatherapy on quality of life in maintenance hemodialysis patients: a systematic review and meta-analysis

Figures & data

Figure 1. PRISMA 2020 flow diagram.

Table 1. Main characteristics of the included studies.

Study	Country	Sample		Intervention		Outcome	Frequency and follow-up	Measure
		T	C	Treatment groups	Control groups
Ahmady et al. [24]	Iran	30	30	Five drops of lavender oil	Five drops of distilled water	Fatigue	Three times a week for 30 min for 2 weeks	FSS
Ahmady et al. [24]	Iran	30	30	Five drops of orange oil	Five drops of distilled water	Fatigue	Three times a week for 30 min for 2 weeks	FSS
Kılıç Akça et al. [22]	Turkey	25	25	Lavender and tea tree oils	Standard care	Pain	Three times a week for 15 min for 8 weeks	VAS
Alireza et al. [25]	Iran	30	30	Three drops of lavender oil	Standard care	Sleep	During dialysis for 4 weeks	PSQI
Efe Arslan and Kılıç Akça [26]	Turkey	22	22	Lavender oil	Standard care	Distress, sleep	Three times a week for 10 min for 4 weeks	DT, PSQI
Arzu [27]	Turkey	17	17	Two drops of lavender oil	Standard care	Anxiety, sleep	30 min before sleep for 1 week	VAS, HAS
Bagheri-Nesami et al. [28]	Iran	30	30	Three drops of lavender oil	Standard care	Fatigue	three times a week for 10 min for 4 weeks	FSS
Barati et al. [20]	Iran	23	23	Rose water	Standard care	Anxiety	Three times a week for 10 min for 4 weeks	SAS
Chen et al. [29]	China	40	38	Chinese herbology incense therapy	Standard care	Anxiety, distress	Once a day for 30–60 min for 4 weeks	SAS, SDS
Dehkordi et al. [30]	Iran	30	30	Three drops of damask rose oil	Standard care	Depression, anxiety, and stress	During dialysis for one hour for 4 weeks.	DASS21
Mohammadpourhodki et al. [21]	Iran	35	35	10–15 cc of 1.5% lavender oil	Standard care	Pain	During dialysis for 20 min twice a day for 4 weeks	SF-36
Mohammadpourhodki et al. [21]	Iran	35	35	10–15 cc of 1.5% citrus Aurantium oil	Standard care	Pain	During dialysis for 20 min three times per week for 4 weeks	SF-36
Ghasemi et al. [19]	Iran	35	35	Aromatherapy massage	Standard care	RLS	Three times a week for 15 min for 3 weeks	RLS rating scale
Ghods et al. [31]	Iran	17	17	Three puffs of lavender oil	Three puffs of water	Pain	three times for 60 min, with an interval of at least 3 d	NRS
Mohammadali Hassanzadeh et al. [32]	Iran	35	35	Two drops of 5% lavender essential oil	Standard care	Fatigue	During dialysis and at home twice a day for 4 weeks	BFI
Huang [33]	China	42	40	1% lavender essential oil	Distilled water	Pain, anxiety	During dialysis for 1 h for 4 weeks	SAI, VAS
Imani et al. [34]	Iran	30	30	Ten drops of lavender oil	Standard care	Pain	During dialysis for 5 min for 4 weeks.	VAS
Imani et al. [34]	Iran	30	30	Ten drops of olive oil	Standard care	Pain	During dialysis for 5 min for 4 weeks	VAS
Karadag et al. [35]	Turkey	30	30	Two drops of lavender oil	Standard care	Anxiety, fatigue	During dialysis for 20 min for 4 weeks.	BAI, FSS
Kiani et al. [36]	Iran	35	35	Two drops of 5% lavender oil and sweet almond oil	Standard care	Anxiety	During dialysis for 20 min twice a day for 4 weeks	STAI
Muz and Taşcı [37]	Turkey	27	35	Sweet orange and lavender oil	Standard care	Fatigue, sleep	During dialysis for 2 min for 4 weeks	VAS, PSQI
Najafi et al. [38]	Turkey	30	30	Lavender essential oil	Standard care	Sleep	Not clear	PSQI
Oshvandi et al. [39]	Iran	35	35	10–15 cc of lavender oil	Standard care	Sleep	Three times a week for 30 min for 3 weeks	RLS rating scale
Oshvandi et al. [39]	Iran	35	35	10–15 cc of sweet orange oil	Standard care	RLS	Three times a week for 30 min for 3 weeks	RLS rating scale
Taşan et al. [40]	Turkey	30	30	Three drops of lavender and sweet almond oil	Standard care	Pain	During dialysis for 3–5 min for 4 weeks	VAS
Varaei et al. [41]	Iran	32	32	Inhalation aromatherapy	Standard care	Fatigue	Three times a week for 20 min for 16 weeks	RFS
Varaei et al. [41]	Iran	32	32	Aromatherapy massage	Standard care	Fatigue	Three times a week for 20 min for 16 weeks	RFS

BAI: Beck Anxiety Inventory; BFI: Brief Fatigue Inventory; DASS-21: Depression Anxiety Stress Scale-21; DT: Distress Thermometers; FSS: Fatigue Severity Scale; HAS: Hamilton Anxiety Scale; NRS: Numeric Rating Scale; PSQI: Pittsburgh Sleep Quality Index; RFS: Rhoten Fatigue Scale; RLS: Restless Legs Syndrome; SAI: State Anxiety Inventory; SAS: State Anxiety Scores; SDS: Self-rating Depression Scale; SF-36: Short Form Health Survey-36; STAI: State Trait Anxiety Inventory; VAS: Visual Analogue Scale

Table 2. Summary of findings.

Quality assessment							Summary of findings
Outcomes	Study design	Risk of bias	Inconsistency	Indirectness	Imprecision	Publication bias	No. of patients		Absolute (95% CI)	Overall quality of evidence
							Treatment	Control
Fatigue	RCT	Not serious	Serious	Not serious	Not serious	Not serious	184	192	−1.32 (−2.58 to −0.05)	⊕⊕⊕◯ Moderate
Pain	RCT	Not serious	Serious	Not serious	Not serious	Not serious	174	172	−1.98 (−3.02 to −0.95)	⊕⊕⊕◯ Moderate
Sleep	RCT	Not serious	Serious	Not serious	Not serious	Not serious	169	161	−1.52 (−2.38 to −0.67)	⊕⊕⊕◯ Moderate
Symptoms of RLS	RCT	Not serious	Serious	Not serious	Not serious	Not serious	70	70	−1.71 (−2.09 to −1.33)	⊕⊕⊕◯ Moderate
Anxiety	RCT	Not serious	Serious	Not serious	Not serious	Not serious	208	281	−1.58 (−2.07 to −1.08)	⊕⊕⊕◯ Moderate

GRADE Working Group grades of evidence.

High quality: Further research is very unlikely to change our confidence in the estimate of the effect.

Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of the effect and may change the estimate.

Low quality: Further research is very likely to have an important impact on our confidence in the estimate of the effect and is likely to change the estimate.

Very low quality: We are very uncertain about the estimate.

Figure 2. Effect of aromatherapy on fatigue in MHD patients.

Figure 3. Effect of aromatherapy on sleep quality in MHD patients.

Figure 4. Effect of aromatherapy on pain in MHD patients.

Figure 5. Effect of aromatherapy on anxiety in MHD patients.

Figure 6. Effect of aromatherapy on symptoms of RLS in MHD patients.

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Data availability statement

Data are available on reasonable request from the authors.