Effect of Benson's Relaxation on Physical, Psychological, and Quality of Life Outcomes in Adults Receiving Hemodialysis: Systematic Review and Meta‐Analysis

BACKGROUND: Adults receiving hemodialysis experience many problems. Benson's relaxation technique has been used to manage these problems, but evidence of its effectiveness is limited. OBJECTIVES: To assess Benson's relaxation effects on physical, psychological outcomes, and quality of life in adults receiving hemodialysis. DESIGN: Systematic review and meta-analysis of randomized controlled trials registered in PROSPERO (CRD42022379551). PARTICIPANTS: Adults receiving hemodialysis. MEASUREMENTS: Eleven databases were searched through January 18, 2024, and updated January 10, 2025. Eligible RCTs involved adults on hemodialysis for at least 3 months, comparing Benson's relaxation with routine care or other interventions. Primary outcomes included physical measures, quality of life, and psychological outcomes; secondary outcomes were narratively reported. Risk of bias was assessed with Cochrane RoB 2.0, and evidence certainty with GRADE. Random-effects meta-analysis and sensitivity analyses used Comprehensive Meta-Analysis v3. RESULTS: Fourteen trials with 1,104 participants provided low-certainty evidence for small effects on serum phosphate (Hedges' g = 0.39, p = 0.010) and large effects on pain (Hedges' g = 1.21, p = 0.010). Very-low-certainty evidence found moderate effects on quality of life (Hedges' g = 0.65, p = 0.010) and large effects on stress (Hedges' g = 1.58, p = 0.017). High-certainty evidence showed small effects on anxiety (Hedges' g = 0.45, p = 0.001). No significant effects were observed for serum calcium or depression symptoms. Sensitivity analyses showed variable robustness. Secondary outcomes were reported narratively. CONCLUSIONS: Overall, current evidence supports cautious clinical interpretation and highlights the need for further rigorous, adequately powered randomized controlled trials. STUDY REGISTRATION: This study is registered in PROSPERO (Registration Number: CRD42022379551, registered on December 8, 2022).