title: Effectiveness of integrating individualized and generic complementary medicine treatments with standard care versus standard care alone for reducing preoperative anxiety.
abstract: OBJECTIVE
  Preoperative anxiety is commonly reported by people undergoing surgery. A significant number of studies have found a correlation between preoperative anxiety and post-operative morbidity. Various methods of complementary and alternative medicine (CAM) were found to be effective in alleviating preoperative anxiety. This study examined the relative effectiveness of various individual and generic CAM methods combined with standard treatment (ST) in relieving preoperative anxiety, in comparison with ST alone.
  
  
  METHODS
  Randomized controlled trial.
  
  
  METHODS
  Holding room area
  
  
  METHODS
  Three hundred sixty patients.
  
  
  METHODS
  Patients were randomly divided into 6 equal-sized groups. Group 1 received the standard treatment (ST) for anxiety alleviation with anxiolytics. The five other groups received the following, together with ST (anxiolytics): Compact Disk Recording of Guided Imagery (CDRGI); acupuncture; individual guided imagery; reflexology; and individual guided imagery combined with reflexology, based on medical staff availability.
  
  
  METHODS
  Assessment of anxiety was taken upon entering the holding room area (surgery preparation room) ('pre-treatment assessment'), and following the treatment, shortly before transfer to the operating room ('post-treatment assessment'), based on the Visual Analogue Scale (VAS) questionnaire. Data processing included comparison of VAS averages in the 'pre' and 'post' stages among the various groups.
  
  
  RESULTS
  Preoperatively, CAM treatments were associated with significant reduction of anxiety level (5.54-2.32, p<0.0001). In contrast, no significant change was noted in the standard treatment group (4.92-5.44, p=0.15). Individualized CAM treatments did not differ significantly in outcomes. However, CDRGI was less effective than individualized CAM (P<0.001), but better than ST (p=0.005).
  
  
  CONCLUSIONS
  Individual CAM treatments integrated within ST reduce preoperative anxiety significantly, compared to standard treatment alone, and are more effective than generic CDRGI. In light of the scope of preoperative anxiety and its implications for public health, integration of CAM therapies with ST should be considered for reducing preoperative anxiety.
authors.affiliation: Complementary & Integrative Surgery Service, and the Surgery Department, Bnai-Zion Medical Center, Israel; School of Public Health, University of Haifa, Israel. Electronic address: samuel.attias@b-zion.gov.il.
authors.forename: Samuel
authors.initials: S
authors.lastname: Attias
authors.affiliation: School of Public Health, University of Haifa, Israel; Israel Center for Disease Control, Ministry of Health, Israel.
authors.forename: Lital
authors.initials: L
authors.lastname: Keinan Boker
authors.affiliation: Complementary & Integrative Surgery Service, and the Surgery Department, Bnai-Zion Medical Center, Israel; Yezreel Valley Academic College, Emek Yezreel, Israel.
authors.forename: Zahi
authors.initials: Z
authors.lastname: Arnon
authors.affiliation: Integrative Oncology Program, the Oncology Service and Lin Medical Center, Clalit Health Services, Haifa, Israel.
authors.forename: Eran
authors.initials: E
authors.lastname: Ben-Arye
authors.affiliation: Department of Anesthesia, Bnai-Zion Medical Center, Haifa, Israel.
authors.forename: Ayala
authors.initials: A
authors.lastname: Bar'am
authors.affiliation: Department of General Surgery, Bnai-Zion Medical Center, Haifa, Israel.
authors.forename: Gideon
authors.initials: G
authors.lastname: Sroka
authors.affiliation: Department of General Surgery, Bnai-Zion Medical Center, Haifa, Israel.
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Matter
authors.affiliation: Department of Anesthesiology, Bnai-Zion Medical Center, Haifa, Israel.
authors.forename: Mostafa
authors.initials: M
authors.lastname: Somri
authors.affiliation: Complementary & Integrative Surgery Service, and the Surgery Department, Bnai-Zion Medical Center, Israel; Internal Medicine Department, Bnai Zion Medical Center, Haifa, Israel.
authors.forename: Elad
authors.initials: E
authors.lastname: Schiff
mesh_terms: D000328:Adult; D000368:Aged; D014151:Anti-Anxiety Agents / Q000627:therapeutic use; D001007:Anxiety / Q000628:therapy*; D003131:Combined Modality Therapy; D000529:Complementary Therapies / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D057285:Precision Medicine / Q000379:methods*; D011300:Preoperative Care / Q000379:methods*; D011569:Psychiatric Status Rating Scales
chemical_list: D014151:Anti-Anxiety Agents
keywords: Complementary and alternative medicine; Holding room area; Integrative medicine; Preoperative anxiety