Comparative Efficacy of Non-Pharmacological Interventions on Anxiety, Depression, Sleep Disorder, and Quality of Life in Patients With Liver Transplantation: A Systematic Review and Network Meta-Analysis

Abstract

Aims: To compare and rank the efficacy of different non-pharmacological interventions on anxiety, depression, sleep disorders, and the quality of life in liver transplantation patients. Background: In recent years, numerous non-pharmacological interventions have been developed to address anxiety, depression, sleep disorders, and the quality of life in liver transplantation patients. However, it remains unclear which non-pharmacological intervention serves as the most effective and preferred approach. Design: A systematic review and network meta-analysis in accordance with the PRISMA guidelines. Methods: Relevant randomised controlled trials were extracted from eight electronic databases. A network meta-analysis was then performed to evaluate the relative efficacy of the non-pharmacological interventions for liver transplantation patients. The quality of the data was assessed using the Cochrane Risk of Bias tool. We registered this study in PROSPERO, number CRD42023450346. Results: A total of 25 randomised controlled trials were included. Spouse support education combined with mindfulness training, individualised psychological intervention, and cognitive behavioural therapy were found to be significantly effective for both anxiety and depression. The top three interventions against anxiety were spouse support education combined with mindfulness training, individualised psychological intervention, and exercise rehabilitation training. Meanwhile, individualised psychological intervention, spouse support education combined with mindfulness training, and cognitive behavioural therapy were the top-ranked three interventions for reducing depression. Sleep hygiene education was the most effective to improve sleep disorders. Continuous care based on a mobile medical platform emerged as the most effective intervention in improving the quality of life. Conclusion: Several non-pharmacological interventions appeared to be effective in treating anxiety, depression, sleep disorders, and improving the quality of life among liver transplantation patients. More high-quality clinical trials should be incorporated in the future to investigate the reliability of existing findings. Relevance to Clinical Practice: Healthcare professionals should be encouraged to apply these promising non-pharmacological interventions during clinical care. No Patient or Public Contribution: This study did not directly involve patients or public contributions to the manuscript.