Varaei 2020.

Study characteristics
Methods	Study design Parallel RCT Study dates Duration of follow‐up: 16 weeks Time frame: not reported
Participants	Study characteristics Setting: multicentre (3 teaching hospitals affiliated to Tehran University of Medical Sciences, Tehran, Iran) Country: Iran Inclusion criteria: > 18 years; minimal HD history of 1 year; 3 HD sessions/week; healthy olfactory function and no history of allergic rhinitis or respiratory disorders; no allergy to aromatic herbs; no participation in aromatherapy or massage therapy programs during the last 6 months before the study; not to take any sleeping pill before aromatherapy and during the course of the study; no history of foot amputation or active skin lesion in the feet; no addiction to opioids; no affliction by debilitating chronic physical conditions such as cardiac, respiratory, liver, or mental disorders according to patients’ medical records Exclusion criteria: death during the study; kidney transplantation during the study Baseline characteristics Number (analysed/randomised): intervention group 1 (32/32); intervention group 2 (32/32); control group (32/32) Mean age ± SD (years): not reported Sex (M/F): not reported Dialysis type: HD Dialysis vintage (years) (mean ± SD): not reported 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 Intervention group 1 Inhalation aromatherapy with lavender essence oil Intervention group 2 Massage aromatherapy with sweet orange essence oil Control group No intervention Co‐interventions Dialysis routine care
Outcomes	Outcomes reported Fatigue outcome measures used: validation data available Fatigue Rhoten fatigue 10‐point VAS scale: assessed at baseline, week 8 and 16 BP
Notes	Additional information Funding: The Tehran Faculty of Nursing and Midwifery and Tehran University of Medical Sciences, Tehran Conflicts of interest/disclosures: none Trial registration identification number: IRCT2014101819564N1 A priori published protocol was reported
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	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	Quote: "This was a three‐group single‐blind randomised controlled trial." Comment: A single blind study is considered as high risk of bias
Blinding of outcome assessment (detection bias) All outcomes	Low risk	Quote: "The biostatistician who analysed the study data was blind to the interventions." Comment: Fatigue 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 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. Other subjective outcomes were assessed. However, the outcome assessment was blinded
Incomplete outcome data (attrition bias) All outcomes	Low risk	All participants completed the study and there was no lost to follow‐up
Selective reporting (reporting bias)	High risk	Information about the protocol were 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	Unclear risk	Baseline characteristics were not clearly reported. Funding was unlikely to influence the data analysis and authors had no conflicts of interest