Application of Distraction Techniques in Obstetrics and Gynaecology: A Systematic Review QE01-QE08
Dr. Mojgan Mirghafourvand,
Social Determinants of Health Research Centre, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, East Azerbaijan, Iran.
Introduction: International institutions have emphasised the role of midwives in ensuring women health, which guarantees family health and its physical, psychological, social, and spiritual aspects. The integration of midwifery knowledge with psychology is a good opportunity for the patients and healthcare providers. Distraction technique is a psychological approach, which has interested the field of medicine.
Aim: To review the effectiveness of Distraction techniques in Obstetrics and Gynaecology.
Materials and Methods: This systematic review study was conducted on articles indexed in Cochrane Library, Web of Sciences, PubMed, Scopus, Google Scholar, CINHAL and Persian databases including SID, Magiran, and Barakat Knowledge Network System in October 2018 without time restriction. Search was conducted according to MeSH-based keywords, including distraction or distraction technique Distraction OR Distraction techniques and use + or AND with keywords Midwife, Birth Attendants, Traditional Midwives, Traditional Birth Attendant, Genital Diseases, Female, Gynaecologic Surgical Procedures, Reproductive Medicine, Obstetrics, Pregnancy Complications, Obstetric Surgical Procedures, Gynaecology and Gynaecological diseases. To ensure, the search process was conducted once again by using keywords of dysmenorrhea, vomiting, nausea, pregnancy, delivery and cesarean section. The inclusion criteria, based on PICOS were: Clients of obstetrics-gynaecology centres; receiving a distraction technique; clinical trials with a parallel design; psychosomatic outcomes; full-text articles in Persian and English. Evaluation of the quality of articles was done using Cochrane Handbook for Systematic Reviews of Interventions version 5.2.0.
Results: Five out of 595 articles were included in this systematic review. Outcomes of these studies were intensity of pain, and stress and anxiety in patients visiting obstetrics-gynaecology centres. Results showed that the distraction techniques could reduce the intensity of pain in patients under obstetrics-gynaecology procedures, and also the stress of prepubescent girls caused by genital examination. Moreover, the meta-analysis results showed that the mean score of anxiety in pregnant women and women at labour, who received distraction interventions, was significantly lower than the control (mean difference: -7.0; 95% Confidence Interval: -13.7 to -0.4; p=0.04).
Conclusion: According to the results, distraction is a simple, low-cost, and accessible technique for reducing pain, anxiety, and stress in the field of obstetrics and gynaecology. Moreover, given that there are scant studies into this field and their high risk of bias, it is recommended to use distraction techniques in different areas of clinical trials with higher quality.