Effectiveness of Non-Pharmacological Manual Therapies for Reducing Fatigue and Muscle Cramps in Hemodialysis Patients: A Systematic Review
(Received: 2026/03/13, Accepted: 2026/06/20)
Authors:
Abiyyu Faqih Dhiyaus suud ahmad; Enny Mulyatsih; Dwi Retno Sulistyaningsih;
Keywords:
Fatigue; Muscle Cramp; Acupressure; Massage; Hemodialysis
Abstract:
<p><strong>Background:</strong> Patients undergoing maintenance hemodialysis commonly experience fatigue and muscle cramps, which may impair daily functioning and quality of life. Manual non-pharmacological therapies have been increasingly used as supportive interventions, but the evidence remains scattered across modalities.<br />
<strong>Aim:</strong> This systematic review aimed to synthesize current evidence on manual therapies for reducing fatigue and muscle cramps in adults receiving maintenance hemodialysis.<br />
<strong>Methods:</strong> A systematic search was conducted in Scopus. Experimental studies involving adult hemodialysis patients and manual therapy-based interventions were included. Methodological quality was assessed using Joanna Briggs Institute critical appraisal tools. Due to heterogeneity in interventions and outcome measures, findings were synthesized narratively.<br />
<strong>Results:</strong> Fourteen studies were included. Interventions comprised acupressure, auricular acupressure or auriculotherapy, massage, reflexology, aromatherapy massage, and combined modalities. Most studies reported improvement in fatigue, with more consistent favorable findings for auricular interventions and reflexology. Massage and acupressure showed mixed results across trials. Evidence for muscle cramps was limited to two studies, both suggesting benefit, although the evidence base was small. Overall study quality was mostly low.<br />
<strong>Conclusion:</strong> Manual therapies may serve as supportive adjuncts for fatigue management in hemodialysis care; however, conclusions remain limited by methodological heterogeneity and study quality. Evidence for muscle cramp reduction is still insufficient and requires more rigorous trials.</p>