Muz 2017.

Study characteristics
Methods	Study design Parallel RCT Study dates Duration of follow‐up: 1 month Time frame: August 2014 to February 2015
Participants	Study characteristics Setting: multicentre (5 HD centres settled in two provinces in Turkey) Country: Turkey Inclusion criteria: ≥ 18 years; no eye or hearing disabilities; voluntary participation in the study; HD for 3 months; continue dialysis in the same unit/centre, undergo HD treatment for 3 sessions/week; not to take any sleeping pill before aromatherapy and during the course of the study; have average or severe fatigue symptoms (VAS fatigue score should be 3 or more); have a score of 5 or more for PSQI; speak Turkish Exclusion criteria: any respiratory system disease; any allergy to essential oils used; any obstacle to smell; use of other integrative medicine applications during treatment Baseline characteristics Number (analysed/randomised): intervention group (27/41); control group (35/39) Mean age ± SD (years): intervention group (52.26 ± 14.50); control group (59.26 ± 12.43) Sex (M/F): intervention group (18/9); control group (16/19) Dialysis type: HD Mean dialysis vintage ± SD (years): intervention group (6.29 ± 3.91); control group (6.24 ± 5.27) Comorbidities CVD: not reported Diabetes: not reported Hypertension: not reported Depression (clinician diagnosis): not reported
Interventions	Intervention classification Non‐pharmacological intervention Indication: study targeting fatigue Treatment group Inhalation of sweet orange and lavender oil every day Control group No intervention Co‐interventions Not reported
Outcomes	Outcomes reported Fatigue outcome measures used: validation data available Sleep quality PSQI (Appendix 3): assessed at baseline and after 1 month Daytime sleepiness dysfunction Subjective sleep quality Sleep latency Sleep duration Habitual sleep efficiency Sleep disturbance Global sleep quality Fatigue 10‐point VAS: assessed at baseline, every week for 1 month PFS (Appendix 3): assessed at baseline, every week for 1 month Behavioural/severity Affective meaning Sensory Cognitive mood Laboratory results (Hb, HCT, albumin, urea, CrCl): assessed at baseline at the end of the study Hospitalisation: assessed until the end of the treatment
Notes	Additional information Funding: supported in part by a grant from the Erciyes University Scientific Research Projects Coordination Unit (no. TDK‐2014‐5222) Conflicts of interest/disclosures: none Trial registration identification number: not reported A priori published protocol: not reported
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Quote: "Random selection of samples was performed." Comment: Sequence generation methods were not reported in sufficient detail to permit judgement
Allocation concealment (selection bias)	Unclear risk	Method of allocation concealment was not reported in sufficient detail to permit judgement
Blinding of participants and personnel (performance bias) All outcomes	High risk	Not reported. However, interventions were different and participants and/or investigators could be aware of the treatment assigned
Blinding of outcome assessment (detection bias) All outcomes	High risk	Quote: "Visual Analogue Scale (VAS) score, Piper fatigue scale, and Pittsburgh Sleep Quality Index (PSQI) were determined via face‐to‐face interview and patient documents. In the first week (the first follow‐up), second week (second follow‐up), and third week (third follow‐up), Visual Analogue Scale (VAS) score and Piper fatigue scale were obtained by the researcher." Comment: The outcomes were assessed with an appropriate measure, without differences between groups. However, subjective measures were used, it was not stated whether outcomes were assessed without knowledge of treatment allocation, and knowledge of treatment assignment may have influenced reporting. Participant/investigators beliefs about the superiority/inferiority of either intervention could have influenced their assessment of the outcome, but there was no evidence that this was likely. However, objective and subjective outcomes were assessed
Incomplete outcome data (attrition bias) All outcomes	High risk	Figure 1 reported the number of participants who did not complete the follow‐up. 27/41 participants in the intervention group and 35/39 participants in the control group completed the study (> 5% lost to follow‐up, with differences between groups)
Selective reporting (reporting bias)	High risk	Information about the protocol and the statistical analysis plan were not reported. Fatigue was reported using multiple eligible outcome measurements (scales, time points). Fatigue was reported in a format that was extractable for meta‐analysis. All outcomes that should be addressed (fatigue, cardiovascular disease, and death) were not reported
Other bias	Low risk	There was no evidence of different baseline characteristics, or different non‐randomised co‐interventions between groups. Funding was unlikely to influence the data analysis and authors had no conflicts of interest. The study seemed to be free from other source of bias