Effect of media distraction (audio-visual and music) for pain and anxiety control in patients undergoing shock-wave lithotripsy: A systematic review and meta-analysis

Abstract

Audio-visual (AV) or music distraction may be used to reduce pain during several healthcare procedures. The present manuscript is a systematic review and meta-analysis to assess the effectiveness of media distraction in reducing pain and anxiety in extracorporeal shock wave lithotripsy (ESWL) patients. The PubMed, Embase, Scopus, BioMed Central, Ovoid and CENTRAL (Cochrane Central Register of Controlled Trials) databases were screened for studies assessing the role of media distraction (music/AV media) in reducing pain and anxiety of ESWL patients. Data were summarized using the mean difference (MD) with 95% confidence intervals (CI). A total of 11 randomized controlled trials were included. Pooled analysis indicated a statistically significant difference in pain outcomes with media distraction [mean difference (MD): -1.18; 95% CI: -2.35, -0.01; I²=96.8%)]. Subgroup analysis indicated that both AV media (MD: -2.94; 95% CI: -4.70, -1.17; I²=79.2%) and music (MD: -0.86; 95% CI: -1.37, -0.35; I²=62.5%), led to significant reduction in pain outcomes. Pooled analysis indicated a statistically significant reduction of anxiety scores with the use of media distraction (MD: -3.91; 95% CI: -6.44, -1.38; I²=77.7%). To conclude, the present review suggests that media distraction in the form of AV media or music may be beneficial in reducing the pain and anxiety of patients undergoing ESWL. Evidence is, however, weak considering the small effect size, confidence intervals being close to zero, and instability of the results on sensitivity analysis. In clinical practice, media distraction may be used during ESWL as a nursing intervention, but a clinically important reduction of pain and anxiety may not be expected.

Keywords: analgesia; audiovisual; complementary therapy; distraction; music; renal stones; urology.

Figure 1

Study flow-chart.

Figure 2

Forest plot of studies comparing media distraction vs. control for the outcome pain with sub-group analysis based on the type of media distraction (audiovisual or music). ^*Indicates different sub-group from the same study.

Figure 3

Sensitivity analysis of pain outcome presenting the resultant effect size after exclusion of one study at a time. Black squares in front of each study indicate the effect size and horizontal lines indicate the 95% confidence intervals, after exclusion of that study from the analysis. ^*Indicates different sub-group from the same study.

Figure 4

Forest plot of studies comparing media distraction vs. control for the outcome pain with sub-group analysis based on the use of noise-cancelling headphones (NCH). ^*Indicates different sub-group from the same study.

Figure 5

Forest plot of studies comparing media distraction vs. control for the outcome anxiety.

Figure 6

Sensitivity analysis of anxiety outcome presenting the resultant effect size after exclusion of one study at a time.^*Indicates different sub-group from the same study.