Breathing exercise techniques (BET) are associated with decreased pain in patients with burn injuries, according to findings from a study published in the International Wound Journal.
The systematic review and meta-analysis were based on a search of electronic databases including Scopus, PubMed, and Web of Science, as well as Iranian electronic databases, through November 1, 2022.
Eligible studies were randomized controlled trials (RCTs) and non-RCTs that focused on the effects of breathing techniques on the pain and anxiety in adult burn patients during burn care compared with a control group. The Joanna Briggs Institute critical appraisal checklist was used to evaluate the quality of the RCTs and quasi-experimental studies.
A total of 10 studies were included in the systematic review, and 9 studies were in the meta-analysis. Pain outcome was based on 3 RCTs in the meta-analysis. In addition, 5 and 3 non-RCT studies reported findings on pain and anxiety, respectively. A single RCT only reported on anxiety, and the weighted mean difference (WMD) was not determined in the analysis.
The 10 studies included 469 burn patients, 58.60% of whom were male, with an overall mean age of 32.84 (SD 10.39) years. The mean study duration was 19 weeks, and 78.05% of participants had second-degree burns.
According to analysis of the RCTs, BET decreased pain severity insignificantly (WMD, -1.17; 95% CI, -2.54 to 0.21; Z=1.66; P =.096; I2, 97.1%) in the intervention group vs the control group. Analysis of the non-RCTs showed that BET significantly decreased pain (WMD, -1.38; 95% CI, -2.16 to -0.61; Z=3.49; P < .001; I2, 88.4%) and anxiety (WMD, -4.91; 95% CI, -9.35 to -0.47; Z=2.71; P < .001; I2, 88.4%) compared with the control group.
The overall effect size of the RCTs was dependent on 1 study, as BET’s effect on pain became significant when excluding that study (WMD, -1.97; 95% CI, -2.41 to -1.54).
The overall effect size of the non-RCTs regarding BET on pain severity did not depend on a single study (CI, -2.16 to -0.60), according to a sensitivity analysis. In addition, the overall effect size of the non-RCTs for the effects of BET on anxiety was not dependent on 1 study (CI, -9.35 to -0.47).
Among several study limitations, only articles in English and Persian were included, and the population size was low.
“It is recommended that health professionals use the findings of this study to consider the use of nondrug interventions such as breathing exercises and routine interventions to reduce pain and anxiety in burn patients,” stated the study authors.
Miri S, Hosseini SJ, Takasi P, et al. Effects of breathing exercise techniques on the pain and anxiety of burn patients: a systematic review and meta-analysis. Int Wound J. Published online December 20, 2022. doi:10.1111/iwj.14057