Guided Relaxation Therapy

Guided relaxation therapy includes progressive muscle relaxation and guided imagery with or without therapeutic touch.  Three moderate quality studies (Forward 2015, Wang 2015, Lin 2012) met inclusion criteria.

In patients undergoing joint arthroplasty Lin et al (Lin 2012) found no differences in average pain score when comparing bed rest to relaxation interventions (in person and recorded), but patients in the intervention arm noted decreased anxiety and better sleep.  Wang (2014) noted less pain after CPM use among patients receiving biofeedback, compared to control patients.  However, no mention was made of differences in opioid use.  Forward (2015) found no differences in reported pain or opioid use among patients receiving guided imagery or therapeutic touch, compared to patients receiving usual care.

Benefits/Harms of Implementation

There seem to be no obvious harms from use of these modalities, and, if future research supports its use, there is the potential benefit of improved patient outcomes and lower opioid use.

Cost Effectiveness/Resource Utilization

The interventions in the noted studies were provided by a variety of healthcare professionals and researchers.  There would be costs associated with the use of this modality for initial and continued training of those involved, and these costs would need to be balanced with improvements in patient outcomes (and decreased lengths of stay) and opioid use. 

Acceptability

Patients are accustomed to interventions or medications for pain control.  There would need to be assessment of acceptance of these techniques among patients undergoing surgical treatment in the US.  There would also need to be education among healthcare professionals in the US about the potential use and impact of these techniques. 

Feasibility

Guided relaxation therapy may not be available to patients undergoing outpatient surgery or in locations where the availability of therapists/biofeedback machines are limited. The cost of these technique and need to have access to appropriately trained personnel could limit use of these modalities, especially in rural/frontier or smaller hospitals.  Given the time constraints of those in most healthcare systems, finding the time needed for patient interaction with this type of intervention may be challenging.  There would need to be more and better data on its effectiveness before most systems would invest the time and resources needed. 

Future Research

The efficacy of guided relaxation therapy has not been established for heterogeneous groups, none of the studies reported results based on sex, and there was inconsistent reporting of what constituted “standard treatment.  Further research should investigate the effect of culture, education status, socioeconomic status, sex, gender, and other demographic variables on the efficacy of guided relaxation therapy after orthopaedic surgery. Furthermore, the optimal timing and method of delivery of guided relaxation therapy has not been established and merits further study. Current studies in this area are limited to specific patient populations (e.g. patients using CPM after joint arthroplasty).  Future studies should include patient undergoing a wider range of procedures.  In addition, given the significant impact of cultural expectations, it is difficult to extrapolate results from other countries to the US.  Additional studies would be required in the US, involving patients from a broad range of gender and racial/ethnic backgrounds, to determine applicability of this technique in the US.  Given the limited access to needed resources to implement relaxation strategies, future research could also assess the impact of providing these virtually to patients in smaller hospitals.