Effect of Vibration, Electrical Stimulation and Other Non-Pharmacological Interventions on Restless Leg Syndrome Severity and Sleep Quality: A Systematic Review and Meta-Analysis.

BACKGROUND AND OBJECTIVES: This study aims to determine the effect of nonpharmacological treatments, such as vibration, electric stimulation, acupressure, massage therapy, cryotherapy, and exercise, on the restless legs syndrome (RLS) severity score. METHODS: Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines were followed for selecting studies to be included in the meta-analysis. The International Prospective Register of Systematic Reviews (PROSPERO) registered this study. Many databases, including Google Scholar, Embase, PubMed, and Scopus, were utilized to locate randomized controlled trials (RCTs). The analysis employed Cochrane's risk of bias tool 2.0 to evaluate the quality of the incorporated RCTs. Standardized mean difference (SMD) figures were employed for all outcomes to assess the impact of every nonpharmacological intervention. The aggregate effect of each was expressed using forest plots. A random-effects model was used for pooling. The heterogeneity of the included studies was evaluated using I2 values. All relevant statistical calculations were carried out using R Studi version 4.3.0. RESULTS: A total of 17 studies were selected for meta-analysis. There was a significant reduction in RLS severity after vibration/stimulation (SMD -1.09, 95% CI -2.45 to -0.27, P = 0.014), and a non-significant trend for acupressure (SMD -0.87, 95% CI -2.21 to 0.47, P = 0.203), massage therapy (SMD -3.49, 95% CI -10.81 to 3.83, P = 0.350), cryotherapy (SMD -1.27, 95% CI -3.72 to 1.18, P = 0.309), and exercise (SMD -2.05, 95% CI -23.95 to 19.84, P = 0.856). There was an improvement in sleep quality measured using the pooled Pittsburgh Sleep Quality Index after the nonpharmacological intervention (SMD: -0.51, 95% CI: -0.73 to -0.28). However, this improvement was not found to be significant ( P = 0.73). CONCLUSIONS: The study demonstrated significant reductions in RLS severity with nonpharmacological interventions, offering viable alternatives to medication. However, the improvement in sleep quality was not statistically significant. Further research is needed to optimize these treatments.