title: The effectiveness of non-pharmacological interventions in improving psychological outcomes for heart transplant recipients: a systematic review.
abstract: BACKGROUND
  Post-heart transplant psychological distress may directly hinder physiological health as well as indirectly impact on clinical outcomes by increasing unhealthy behaviors, such as immunosuppression non-adherence. Reducing psychological distress for heart transplant recipients is therefore vitally important in order to improve not only patients' overall health and well-being but also clinical outcomes, such as morbidity and mortality. Evidence from other populations suggests that non-pharmacological interventions may be an effective strategy.
  
  
  OBJECTIVE
  The purpose of this study was to appraise the efficacy of non-pharmacological interventions on psychological outcomes after heart transplant.
  
  
  METHODS
  A systematic review was conducted using the Joanna Briggs Institute methodology. Experimental and quasi-experimental studies that involved any non-pharmacological intervention for heart transplant recipients were included, provided that data on psychological outcomes were reported. Multiple electronic databases were searched for published and unpublished studies and reference lists of retrieved studies were scrutinized for further primary research. Data were extracted using a standardized data extraction tool. Included studies were assessed by two independent reviewers using standardized critical appraisal instruments.
  
  
  RESULTS
  Three studies fulfilled the inclusion and exclusion criteria, which involved only 125 heart transplant recipients. Two studies reported on exercise programs. One study reported a web-based psychosocial intervention. While psychological outcomes significantly improved from baseline to follow-up for the recipients who received the interventions, between-group comparisons were not reported. The methodological quality of the studies was judged to be poor.
  
  
  CONCLUSIONS
  Further research is required, as we found there is insufficient evidence available to draw conclusions for or against the use of non-pharmacological interventions after heart transplant.
authors.affiliation: 1School of Nursing and Institute of Health and Biomedical Innovation, Queensland University of Technology, Australia.
authors.forename: Aaron
authors.initials: A
authors.lastname: Conway
authors.forename: Verena
authors.initials: V
authors.lastname: Schadewaldt
authors.forename: Robyn
authors.initials: R
authors.lastname: Clark
authors.forename: Chantal
authors.initials: C
authors.lastname: Ski
authors.forename: David R
authors.initials: DR
authors.lastname: Thompson
authors.forename: Kathryn
authors.initials: K
authors.lastname: Kynoch
authors.forename: Lynn
authors.initials: L
authors.lastname: Doering
mesh_terms: D001007:Anxiety / Q000451:nursing / Q000523:psychology; D064646:Cardiovascular Nursing / Q000379:methods*; D003863:Depression / Q000451:nursing / Q000523:psychology; D016027:Heart Transplantation / Q000451:nursing* / Q000523:psychology*; D006801:Humans; D055118:Medication Adherence / Q000523:psychology*; D011788:Quality of Life / Q000523:psychology*
keywords: Heart transplant; anxiety; depression; quality of life; systematic review