Effect of Physiotherapy-Based Relaxation Interventions on Insomnia in Older Adults: A Systematic Review

Abstract

Abstract Background Insomnia affects up to half of community-dwelling older adults, impairing cognition, mood, and physical function. Although pharmacotherapy is common, safety concerns in late-life have fuelled interest in non-drug approaches, including physiotherapy-based relaxation techniques. Objective To determine whether physiotherapy-delivered relaxation interventions improve sleep quality in adults ≥60 years with insomnia, compared with usual care or no treatment, using validated patient-reported outcomes. Methods A protocol was drafted a priori following PRISMA 2020 and registered prospectively in PROSPERO (CRD420XXXXX). MEDLINE (via PubMed), EMBASE, PEDro, CINAHL, and the Cochrane Central Register of Controlled Trials were searched from inception to 31 March 2025 without language limits. Search strings combined terms for older adults, insomnia/sleep disturbance, physiotherapy/physical therapy, and relaxation (e.g. "progressive muscle relaxation", "breathing exercises"). Randomised controlled trials (RCTs) evaluating any physiotherapist-led relaxation technique and reporting the Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), or Sleep Quality Scale (SQS) were eligible. Two reviewers independently screened records, extracted data, and assessed risk of bias using Cochrane RoB 2. Disagreements were resolved by consensus. Planned meta-analysis required ≥2 clinically homogeneous trials. Results Of 528 unique records, 24 full-text articles were assessed; none met all eligibility criteria. The primary reasons for exclusion were: intervention not delivered by a physiotherapist (n = 9), population <60 years (n = 7), absence of validated sleep outcome (n = 5), and non-randomised design (n = 3). Consequently, no quantitative synthesis was possible. Conclusion No RCTs have investigated physiotherapist-delivered relaxation techniques for insomnia in older adults using validated sleep measures. Well-designed trials are urgently needed to guide safe, non-pharmacological management of late-life insomnia. Keywords: Older adults; Insomnia; Physiotherapy; Relaxation therapy; Progressive muscle relaxation; Systematic review; PRISMA