Effect of waiting room ambience on the stress and anxiety of patients undergoing medical treatment: a systematic review and meta-analysis

Objective We systematically reviewed different waiting room designs and interventions during the waiting time, before medical or dental treatment. The risk of bias was assessed using the Newcastle-Ottawa scale and the Cochrane Collaboration’s tool. Data Studies reporting on different interventions in medical waiting areas and parameters like heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure DBP), respiratory rate (RR) and/or anxiety [state trait anxiety inventory (STAI), visual analogue scale (VAS)] and mood [multi-dimensional mood state questionnaire (MDBF)] were included. Two authors independently searched and extracted records. Sources Electronic databases (PubMed, Embase, Cochrane CENTRAL, Google Scholar) were screened, and hand searches and cross-referencing performed. Study selection 81 articles were included for qualitative (n=53) and quantitative (n=28) analyses. The meta-analysis revealed significant reduction in the patient’s HR when exposed to aquariums for 20minutes (p=0.02), animal/bird/aquarium videos (p=0.001). BP was significantly reduced by listening to music for <20minutes (SBP: p=0.011; DBP: p=0.029). Overall subjective assessments revealed a significant reduction (p<0.001) in anxiety by music and aroma therapy (>20minutes: p<0.001; <20minutes: p=0.014). Conclusions Optimal exposure time to aquariums, animal/bird/aquarium videos, aromatherapy, or listening to music may have a positive impact on the pre-treatment stress and anxiety of patients waiting to undergo a medical procedure. Clinical Significance Music, aroma and aquarium interventions in waiting areas can be recommended for clinical practice. The side effect profile is low and all three interventions show an anxiety-reducing effect, when waiting times are 20minutes and more. Dentists could use the waiting area to reduce stress and anxiety in their patients.