Standardized Mean Effect Size Research Articles

Treatment of post-burn pruritus – A systematic review and meta-analysis

BackgroundPost-burn pruritus is one of the most common complaints reported by patients with limited evidence for a gold-standard treatment. ObjectiveTo review the literature and assess the efficacy of various interventions in treating post-burn pruritus. MethodsPubMed, MEDLINE, CINAHL, Web of Sciences, Ovid Databases, and ClinicalTrials.Gov were searched. The articles were scored by two assessors for inclusion with a third independent assessor resolving conflicting scores. ResultsThe present systematic review and meta-analysis synthesised findings from a total of nine studies, representing a pool of 323 patients. The standardized mean effect size for the various categories of interventions was: naltrexone at 1.47 (95 % CI of 0.75–2.20, p < 0.0000), coverings at 0.94 (95 % CI of 0.40–1.48, p = 0.006), topical ozonated oil at 2.64 (95 % CI of 1.94–3.34, p < 0.00001), lasers at 2.34 (95 % CI of 1.60–3.09, p < 0.00001), current stimulation at 1.03 (95 % CI of −0.04 to 2.10, p = 0.06), and lemon balm tea at 0.54 (95% CI of 0.12–0.96, p = 0.01). ConclusionsCurrent evidence suggests that current modalities have a statistically significant, but not clinically significant, reduction in pruritus. This review highlights the limited quality of evidence in the literature and the poor quality of reporting among excluded studies.

Evaluation of a decided sample size in machine learning applications

BackgroundAn appropriate sample size is essential for obtaining a precise and reliable outcome of a study. In machine learning (ML), studies with inadequate samples suffer from overfitting of data and have a lower probability of producing true effects, while the increment in sample size increases the accuracy of prediction but may not cause a significant change after a certain sample size. Existing statistical approaches using standardized mean difference, effect size, and statistical power for determining sample size are potentially biased due to miscalculations or lack of experimental details. This study aims to design criteria for evaluating sample size in ML studies. We examined the average and grand effect sizes and the performance of five ML methods using simulated datasets and three real datasets to derive the criteria for sample size. We systematically increase the sample size, starting from 16, by randomly sampling and examine the impact of sample size on classifiers’ performance and both effect sizes. Tenfold cross-validation was used to quantify the accuracy.ResultsThe results demonstrate that the effect sizes and the classification accuracies increase while the variances in effect sizes shrink with the increment of samples when the datasets have a good discriminative power between two classes. By contrast, indeterminate datasets had poor effect sizes and classification accuracies, which did not improve by increasing sample size in both simulated and real datasets. A good dataset exhibited a significant difference in average and grand effect sizes. We derived two criteria based on the above findings to assess a decided sample size by combining the effect size and the ML accuracy. The sample size is considered suitable when it has appropriate effect sizes (≥ 0.5) and ML accuracy (≥ 80%). After an appropriate sample size, the increment in samples will not benefit as it will not significantly change the effect size and accuracy, thereby resulting in a good cost-benefit ratio.ConclusionWe believe that these practical criteria can be used as a reference for both the authors and editors to evaluate whether the selected sample size is adequate for a study.

The use of peer support groups for emergency physicians during the COVID-19 pandemic.

To test the feasibility, receptivity, and preliminary effectiveness of peer support groups for emergency medicine physicians during the COVID-19 pandemic and gain a better understanding of their experiences with peer support. This pilot study used a quasi-experimental design to assess change in symptoms of distress, anxiety, depression and burn-out before and after participating in a virtual, group-based peer support intervention for a duration of 8 weeks. Pre-post change analyses were performed using two-sided, paired t tests. Feasibility was measured by attendance data to demonstrate the use of the intervention. Receptivity was measured using a global change rating and net promoter score at the end of each session and 8-week period, respectively. During the final session, qualitative data on physician experience was collected and then analyzed using conventional content analysis. Twenty-four emergency medicine physicians participated in the pilot study. The attendance goal was met by 20 (24, 83%) physicians and 19 (22, 86%) physicians reported they would recommend peer support groups to a friend of colleague. Positive standardized response mean effect sizes indicated modest improvement in nine of 12 symptom measurements with marginal significance (p < 0.10) for improvement in guilt [20, EffectSize(ES) = 0.45] and depression (21, ES = 0.39). Qualitative findings revealed high overall benefit with few adverse impacts of participation. Results demonstrate high physician receptivity, feasibility, and benefit from participation in peer support groups. Promising signs of improvement in distress, anxiety, depression, and burn out symptoms warrant additional studies with larger sample sizes and more robust research designs to establish the evidence base for peer support in the physicianpopulation.

Is EQ-5D-5L Better Than EQ-5D-3L Over Time? A Head-to-Head Comparison of Responsiveness of Descriptive Systems and Value Sets from Nine Countries.

ObjectivesThe aim of this study was to compare the responsiveness of EQ-5D-3L (3L) with EQ-5D-5L (5L) descriptive systems and value sets in two independent samples (rehabilitation and stroke patients).MethodsDescriptive system results were compared cross-sectionally, and descriptive responsiveness was tested by calculating changed level responses (‘moves’) from baseline to follow-up, proportion of improved patients, Paretian Classification of Health Change (PCHC), and probability of superiority (PS). Responsiveness of values based on nine country-specific value sets was assessed by standardized response mean (SRM) and standardized effect size (SES). Relative efficiency of 5L over 3L was assessed by calculating ratios of the SRM and SES statistics.ResultsDescriptive comparisons confirmed earlier evidence and showed a consistent overestimation of health problems in 3L. Descriptive responsiveness improved with 5L in terms of moves per respondent, proportions of improved patients and PS, whereas PCHC showed mixed results. Better value responsiveness statistics were observed for 5L in rehabilitation patients for all value sets. In stroke patients, 3L showed better responsiveness statistics compared with 5L. Relative efficiency results were moderately to strongly better with 5L for rehabilitation, and slightly to moderately better with 3L for stroke.ConclusionsDescriptive results were the main driver of 3L–5L responsiveness differences. Responsiveness of 3L was influenced by the ‘confined to bed’ label and the overestimation bias of 3L, which affected all responsiveness results. This may impact quality-adjusted life-year (QALY) estimations, leading to over- or underestimations of QALYs gained, depending on the condition and condition severity. QALY calculations based on 5L data will result in more accurate estimates.

The Effectiveness of Hearing Protection Devices: A Systematic Review and Meta-Analysis.

To prevent intensive noise exposure in advance and be safely controlled during such exposure, hearing protection devices (HPDs) have been widely used by workers. The present study evaluates the effectiveness of these HPDs, partitioned into three different outcomes, such as sound attenuation, sound localization, and speech perception. Seven electronic journal databases were used to search for published articles from 2000 to 2021. Based on inclusion criteria, 20 articles were chosen and then analyzed. For a systematic review and meta-analysis, standardized mean differences (SMDs) and effect size were calculated using a random-effect model. The funnel plot and Egger’s regression analysis were conducted to assess the risk of bias. From the overall results of the included 20 articles, we found that the HPD function performed significantly well for their users (SMDs: 0.457, 95% confidence interval (CI): 0.034–0.881, p < 0.05). Specifically, a subgroup analysis showed a meaningful difference in sound attenuation (SMDs: 1.080, 95% CI: 0.167–1.993, p < 0.05) when to wear and not to wear HPDs, but indicated no significance between the groups for sound localization (SMDs: 0.177, 95% CI: 0.540–0.894, p = 0.628) and speech perception (SMDs: 0.366, 95% CI: −0.100–1.086, p = 0.103). The HPDs work well for their originally designated purposes without interfering to find the location of the sound sources and for talking between the workers. Taking into account various factors, such as the characteristics of the users, selection of appropriate types, and fitting methods for wearing in different circumstances, seems to be necessary for a reliable systematic analysis in terms of offering the most useful information to the workers.

Agreement Between A 2-Dimensional Digital Image-Based 3-Compartment Body Composition Model and Dual Energy X-Ray Absorptiometry for The Estimation of Relative Adiposity

The purpose of this study was to compare relative adiposity (%Fat) derived from a 2-dimensional image-based 3-component (3C) model (%Fat3C-IMAGE) and dual-energy X-ray absorptiometry (DXA) (%FatDXA) against a 5-component (5C) laboratory criterion (%Fat5C). 57 participants were included (63.2% male, 84.2% White/Caucasian, 22.5±4.7 yrs., 23.9±2.8 kg/m2). For each participant, body mass and standing height were measured to the nearest 0.1 kg and 0.1 cm, respectively. A digital image of each participant was taken using a 9.7 inch, 16g iPad Air 2 and analyzed using a commercially available application (version 1.1.2, made Health and Fitness, USA) for the estimation of body volume (BV) and inclusion in %Fat3C-IMAGE . %Fat3C-IMAGE and %Fat5C included measures of total body water derived from bioimpedance spectroscopy. The criterion %Fat5C included BV estimates derived from underwater weighing and bone mineral content measures via DXA. %FatDXA estimates were calculated from a whole-body DXA scan. A standardized mean effect size (ES) assessed the magnitude of differences between models with values of 0.2, 0.5, and 0.8 for small, moderate, and large differences, respectively. Data are presented as mean ± standard deviation. A strong correlation (r = 0.94, p <.001) and small mean difference (ES = 0.24, p <.001) was observed between %Fat3C-IMAGE (19.20±5.80) and %Fat5C (17.69±6.20) whereas a strong correlation (r = 0.87, p <.001) and moderate-large mean difference (ES = 0.70, p <.001) was observed between %FatDXA (22.01±6.81) and %Fat5C. Furthermore, %Fat3C-IMAGE (SEE = 2.20 %Fat, TE= 2.6) exhibited smaller SEE and TE than %FatDXA (SEE = 3.14 %Fat, TE = 5.5). The 3C image-based model performed slightly better in our sample of young adults than the DXA 3C model. Thus, the 2D image analysis program provides an accurate and non-invasive estimate of %Fat within a 3C model in young adults. Compared to DXA, the 3C image-based model allows for a more cost-effective and portable method of body composition assessment, potentially increasing accessibility to multi-component methods.

Validity of a 3-compartment body composition model using body volume derived from a novel 2-dimensional image analysis program.

The purpose of this study was: (1) to compare body volume (BV) estimated from a 2-dimensional (2D) image analysis program (BVIMAGE), and a dual-energy x-ray absorptiometry (DXA) equation (BVDXA-Smith-Ryan) to an underwater weighing (UWW) criterion (BVUWW); (2) to compare relative adiposity (%Fat) derived from a 3-compartment (3C) model using BVIMAGE (%Fat3C-IMAGE), and a 4-compartment (4C) model using BVDXA-Smith-Ryan (%Fat4C-DXA-Smith-Ryan) to a 4C criterion model using BVUWW (%Fat4C-UWW). Forty-eight participants were included (60% male, 22.9 ± 5.0 years, 24.2 ± 2.6 kg/m2). BVIMAGE was derived using a single digital image of each participant taken from the rear/posterior view. DXA-derived BV was calculated according to Smith-Ryan et al. Bioimpedance spectroscopy and DXA were used to measure total body water and bone mineral content, respectively, in the 3C and 4C models. A standardized mean effect size (ES) assessed the magnitude of differences between models with values of 0.2, 0.5, and 0.8 for small, moderate, and large differences, respectively. Data are presented as mean ± standard deviation. Near-perfect correlation (r = 0.998, p < 0.001) and no mean differences (p = 0.267) were observed between BVIMAGE (69.6 ± 11.5 L) and BVUWW (69.5 ± 11.4 L). No mean differences were observed between %Fat4C-DXA-Smith-Ryan and the %Fat4C-UWW criterion (p = 0.988). Small mean differences were observed between %Fat3C-IMAGE and %Fat4C-UWW (ES = 0.2, p < 0.001). %Fat3C-IMAGE exhibited smaller SEE and TE, and tighter limits of agreement than %Fat4C-DXA-Smith-Ryan. The 2D image analysis program provided an accurate and non-invasive estimate of BV, and subsequently %Fat within a 3C model in generally healthy, young adults.

Investigating the Bias in Orthopaedic Patient-reported Outcome Measures by Mode of Administration: A Meta-analysis.

Background:Patient-reported outcome measures (PROMs) are critical and frequently used to assess clinical outcomes to support medical decision-making.Questions/Purpose:The purpose of this meta-analysis was to compare differences in the modes of administration of PROMs within the field of orthopaedics to determine their impact on clinical outcome assessment.Patients and Methods:The PubMed database was used to conduct a review of literature from 1990 to 2018 with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol. All articles comparing PROMs for orthopaedic procedures were included and classified by the mode of administration. Each specific survey was standardized to a scale of 0 to 100, and a repeated random effectsmodel meta-analysis was conducted to determine the mean effect of each mode of survey.Results:Eighteen studies were initially included in the study, with 10 ultimately used in the meta-analysis that encompassed 2384 separate patient survey encounters. Six of these studies demonstrated a statistically notable difference in PROM scores by mode of administration. The meta-analysis found that the standardized mean effect size for telephone-based surveys on a 100-point scale was 71.7 (SE 5.0) that was significantly higher (P , 0.0001) than survey scores obtained via online/tech based (65.3 [SE 0.70]) or self-administered/paper surveys (61.2 [SE 0.70]).Conclusions:Overall, this study demonstrated that a documented difference exists in PROM quality depending on the mode of administration. PROM scores obtained via telephone (71.7) are 8.9% higher than scores obtained online (65.3, P , 0.0001), and 13.8% higher than scores obtained via self-administered on paper (61.8, P , 0.0001). Few studies have quantified statistically notable differences between PROM scores based solely on the mode of acquisition in orthopaedic

A meta-analysis of client-therapist perspectives on the therapeutic alliance: Examining the moderating role of type of measurement and diagnosis.

Clients and therapists often have different perspectives on their therapeutic alliance (TA), affecting the process and outcome of therapy. The aim of the present meta-analysis was to assess the mean differences between clients' and therapists' estimations of TA among clients with severe disturbances, while focusing on two potential moderators: client diagnosis and alliance instrument. We conducted a systematic literature search of studies examining both client perspective and therapist perspective on TA in psychotherapy among people with schizophrenia spectrum disorders, personality disorders, and substance misuse disorders. We then analyzed the data using a random-effects meta-analytic model with Cohen's d standardized mean effect size. Heterogeneity analyses (k=22, Cohen's d=-.46, 95% confidence interval=.31-1.1) produced a significant Q-statistic (Q=94.96) and indicated high heterogeneity, suggesting that moderator analyses were appropriate. Our findings show that the type of TA instrument moderates the agreement on TA between client and therapist, but there was no indication of the client's diagnosis moderating the effect. The agreement between client and therapist estimations seems to be dependent on the instrument that is used to assess TA. Specific setting-related instruments seem to result in higher agreement between clients' and therapists' estimations than do more general instruments that are applied to assess TA.

Effect of Postactivation Potentiation on Explosive Vertical Jump: A Systematic Review and Meta-Analysis.

Dobbs, WC, Tolusso, DV, Fedewa, MV, and Esco, MR. Effect of postactivation potentiation on explosive vertical jump: a systematic review and meta-analysis. J Strength Cond Res 33(7): 2009-2018, 2019-The primary aim of this systematic review and meta-analysis was to quantify the magnitude of the effect of postactivation potentiation (PAP) on explosive vertical power while accounting for the nesting of multiple effects within each study. This study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Statement (PRISMA). Original research articles published by January 18, 2018, were located using an electronic search of 4 databases and yielded 759 original publications. Data were extracted and independently coded by 2 authors (W.C.D. and D.V.T.). The standardized mean effect size (ES) was calculated by subtracting the pre-treatment mean from the post-treatment mean and dividing by the pooled SD, adjusting for small sample bias. Multilevel random-effects model was used to aggregate a mean ES and 95% confidence interval (CI) for PAP on vertical jump performance. The cumulative results of 179 effects gathered from 36 studies indicate that PAP does not improve vertical jump performance (ES = 0.08, 95% CI -0.04 to 0.21, p = 0.197), with moderate heterogeneity. Moderator analysis indicated that rest intervals between 3 and 7 minutes provided favorable performance outcomes (ES = 0.18, 95% CI 0.05 to 0.31, p = 0.007). Conversely, rest intervals less than 3 minutes (ES = -0.15, 95% CI -0.31 to 0.01, p = 0.052) or performing isometric contractions (ES = -0.52, 95% CI -0.89 to -0.14, p = 0.007) may be detrimental to performance. Meta-regression indicated that rest interval was the only moderator significantly associated with ES (β = -0.04, 95% CI -0.57 to -0.02, R = 14.31%, p < 0.001). When appropriate PAP guidelines are followed, an increase in vertical jump performance may be achieved.

Dry Needling Improves Static and Dynamic Balance in Individuals with Chronic Ankle Instability

Individuals with chronic ankle instability (CAI) commonly exhibit balance deficits that are associated with dysfunction of the fibularis longus (FL) muscle. Dry needling (DN) is a treatment that targets muscular trigger points and is hypothesized to improve neurophysiological function of treated muscles. The ability of FL DN to improve dynamic and static balance in patients with CAI is unknown. PURPOSE: Examine the effect of FL DN on dynamic and static balance in individuals with CAI. METHODS: Twenty-five adults with CAI (9 males, 16 females; 26±9.42 years; 173.12±9.85cm; 79.27±18kg) volunteered to participate. Participants completed the Star Excursion Balance Test (SEBT) and postural control measures before and immediately after a single DN treatment to the FL. The anterior, posterolateral, and posteromedial directions of the SEBT were tested in a random order and reach distances were normalized to a percent of leg length. A composite SEBT score was calculated by dividing the normalized, average scores in each direction by three. Postural control was assessed in single-limb stance on a forceplate through time to boundary (TTB) measurements and calculated in the mediolateral and anteroposterior directions under eyes open and eyes closed conditions. A single DN treatment was performed on the FL using a “pistoning” technique. Descriptive statistics (mean change ± SD), paired t-tests, and standardized response mean effect sizes were calculated to compare balance measures before and immediately after the FL DN intervention (p≤0.05). RESULTS: Following DN, significant improvements were identified in the composite (3.98± 4.45%, p<0.001, ES=0.89), posteromedial (4.85±5.75%, p <0.001, ES=0.84) and posterolateral reach directions (4.96±5.49%, p<0.001, ES=0.90) but not in the anterior reach direction (2.11±5.77%, p=0.08, ES=0.37). Under eyes-open conditions, TTB improved in the mediolateral (0.27±0.43, p=0.004, ES=0.63) and anteroposterior (0.84±1.43, p=0.007, ES=0.59) directions., However, no significant changes were identified in any TTB measures with eyes closed (p≤0.20). CONCLUSIONS: FL DN created immediate improvements in dynamic and static balance in individuals with CAI. Future studies should examine the effects of multiple DN treatments and the mechanism behind this therapeutic effect.

The effect of resistance training on health-related quality of life in older adults: Systematic review and meta-analysis.

Background: Resistance training (RT) is recommended as part of our national physical activity guidelines which includes working all major muscle groups on two or more days a week.Older adults can gain many health benefits from RT, such as increased muscle strength,increased muscle mass, and maintenance of bone density. Additionally, certain dimensions of health-related quality of life (HRQOL) have been shown to improve in older adults due to RT intervention. The purpose of this study was to use systematic review and meta-analytic techniques to examine the effect of RT on HRQOL in older adults. Methods: A systematic review of current studies (2008 thru 2017) was conducted using PubMed. Studies were included if they used a randomized controlled design, had RT as an intervention, measured HRQOL using the SF-36/12 assessment, and included adults 50+ years of age. Eight dimension scores (physical functioning, bodily pain, physical role function, general health, mental health, emotional role function, social function, and vitality) and two summary scores (physical component and mental component) were extracted. Ten meta-analyses were performed using standardized mean effect sizes and random effects models. Study quality,moderator and sensitivity analyses were conducted. Results: A total of 16 studies were included in the analyses with a mean Physiotherapy Evidence Database (PEDro) score of 4.9 (SD=1.0). Among the mental health measures, RT had the greatest effect on mental health (Effect size [ES]=0.64, 95% CI: 0.30-0.99, I2=79.7). Among the physical health measures, RT had the largest effect on body pain (ES=0.81, 95% CI: 0.26-1.35, I2=85.9).Initially, RT did not significantly affect measures of emotional role function, social function or physical role function. However, after removing a single study, RT significantly increased all HRQOL measures. Conclusion: The meta-analytic evidence presented in this research clearly supports the promotion of RT in improving HRQOL in older adults.

Responsiveness of five measures of arm function in acute stroke rehabilitation

Objective: To determine the responsiveness of five arm function measures in people receiving acute inpatient stroke rehabilitation. Design: Inception cohort study. Setting: Comprehensive stroke unit providing early rehabilitation. Subjects: A total of 64 consecutively admitted stroke survivors with moderately severe disability (Modified Rankin Scale score median (interquartile range (IQR)): 4.0 (1.0)). Main measures: Responsiveness was analyzed by calculating effect size, standardized response mean and median-based effect size. Floor/ceiling effects were calculated as the percentage of participants scoring the lowest/highest possible scores. Results: Average length of stay and number of therapy days were 34 (SD = 27.9) and 12 (SD = 13.1), respectively. Box and Block Test and Functional Independence Measure–Self-Care showed the highest responsiveness with values in the moderate–large range (effect size = 1.09, standardized response mean = 1.07 and median-based effect size = 0.76; effect size = 0.94, standardized response mean = 1.04 and median-based effect size = 1.0). Responsiveness of Action Research Arm Test and Upper Limb–Motor Assessment Scale were moderate (effect size = 0.58, standardized response mean = 0.69 and median-based effect size = 0.59; effect size = 0.62, standardized response mean = 0.75 and median-based effect size = 0.67). For Manual Muscle Test, responsiveness was in the small–moderate range (effect size = 0.42, standardized response mean = 0.59 and median-based effect size = 0.5). Box and Block Test showed the largest floor effect on admission (28%), and Action Research Arm Test and Manual Muscle Test showed the largest ceiling effect on discharge (31%). Conclusion: These five measures varied in their ability to detect change with responsiveness ranging from the small to large range. Box and Block Test and Functional Independence Measure–Self-Care showed a greater ability to detect change; both demonstrated moderate–large responsiveness.

The association between metacognitive abilities and outcome measures among people with schizophrenia: A meta-analysis

BackgroundDeficits in metacognition are one of the major causes of the difficulties experienced by individuals with schizophrenia. Studies have linked these deficits to symptom exacerbation and deterioration in psychosocial functioning. The aim of the present meta-analysis was to examine the extensive existing literature regarding metacognitive deficits among persons with schizophrenia; a further aim was to assess the extent to which metacognitive abilities are linked to outcome measures of symptoms and psychosocial functioning. MethodWe conducted a systematic literature search of studies examining the relationship between metacognitive abilities and outcome measures among people with schizophrenia. We then analyzed the data using a random-effects meta-analytic model with Cohen's d standardized mean effect size. ResultsHeterogeneity analyses (k=32, Cohen's d=−.12, 95% CI.−1.92 to 1.7) produced a significant Q-statistic (Q=456.89) and a high amount of heterogeneity, as indicated by the I2 statistic (93.04%), suggesting that moderator analyses were appropriate. As hypothesized, measure type moderated the metacognitive deficit with homogenous effect for psychosocial functioning measures (Q=9.81, I2=19.47%, d=.94. 95% CI .58 to 1.2) and symptoms (Q=19.87, I2=0%, d=−1.07, 95% CI −1.18 to −.75). Further analysis found homogenous effects for MAS-A subscales as well as PANSS factors of symptoms. ConclusionOur meta-analysis results illustrated a significant association between metacognitive deficits and both symptomatic and psychosocial functioning measures. These links suggest that the associations between metacognitive abilities and symptomatic outcomes are different from those between metacognitive abilities and psychosocial functioning measures. Intriguing hypotheses are raised regarding the role that metacognitive abilities play in both symptoms and psychosocial functioning measures of people diagnosed with schizophrenia spectrum disorders.

Compression Garments and Recovery from Exercise: A Meta-Analysis.

Adequate recovery from exercise is essential to maintain performance throughout training and competition. While compression garments (CG) have been demonstrated to accelerate recovery, the literature is clouded by conflicting results and uncertainty over the optimal conditions of use. A meta-analysis was conducted to assess the effects of CG on the recovery of strength, power and endurance performance following an initial bout of resistance, running, or non-load-bearing endurance (metabolic) exercise. Change-score data were extracted from 23 peer-reviewed studies on healthy participants. Recovery was quantified by converting into standardized mean effect sizes (ES) [±95% confidence interval (CI)]. The effects of time (0-2, 2-8, 24, >24h), pressure (<15 vs. ≥15mmHg) and training status (trained vs. untrained) were also assessed. CG demonstrated small, very likely benefits [p<0.001, ES=0.38 (95% CI 0.25, 0.51)], which were not influenced by pressure (p=0.06) or training status (p=0.64). Strength recovery was subject to greater benefits than other outcomes [p<0.001, ES=0.62 (95% CI 0.39, 0.84)], displaying large, very likely benefits at 2-8h [p<0.001, ES=1.14 (95% CI 0.72, 1.56)] and >24h [p<0.001, ES=1.03 (95% CI 0.48, 1.57)]. Recovery from using CG was greatest following resistance exercise [p<0.001, ES=0.49 (95% CI 0.37, 0.61)], demonstrating the largest, very likely benefits at >24h [p<0.001, ES=1.33 (95% CI 0.80, 1.85)]. Recovery from metabolic exercise (p=0.01) was significant, although large, very likely benefits emerged only for cycling performance at 24h post-exercise [p=0.01, ES=1.05 (95% CI 0.25, 1.85)]. The largest benefits resulting from CG were for strength recovery from 2 to 8h and >24h. Considering exercise modality, compression most effectively enhanced recovery from resistance exercise, particularly at time points >24h. The use of CG would also be recommended to enhance next-day cycling performance. The benefits of CG in relation to applied pressures and participant training status are unclear and limited by the paucity of reported data.

Effect of study design on the reported effect of cardiac resynchronization therapy (CRT) on quantitative physiological measures: stratified meta-analysis in narrow-QRS heart failure and implications for planning future studies.

BackgroundBiventricular pacing (CRT) shows clear benefits in heart failure with wide QRS, but results in narrow QRS have appeared conflicting. We tested the hypothesis that study design might have influenced findings.Method and ResultsWe identified all reports of CRT‐P/D therapy in subjects with narrow QRS reporting effects on continuous physiological variables. Twelve studies (2074 patients) met these criteria. Studies were stratified by presence of bias‐resistance steps: the presence of a randomized control arm over a single arm, and blinded outcome measurement. Change in each endpoint was quantified using a standardized effect size (Cohen's d). We conducted separate meta‐analyses for each variable in turn, stratified by trial quality. In non‐randomized, non‐blinded studies, the majority of variables (10 of 12, 83%) showed significant improvement, ranging from a standardized mean effect size of +1.57 (95%CI +0.43 to +2.7) for ejection fraction to +2.87 (+1.78 to +3.95) for NYHA class. In the randomized, non‐blinded study, only 3 out of 6 variables (50%) showed improvement. For the randomized blinded studies, 0 out of 9 variables (0%) showed benefit, ranging from −0.04 (−0.31 to +0.22) for ejection fraction to −0.1 (−0.73 to +0.53) for 6‐minute walk test.ConclusionsDifferences in degrees of resistance to bias, rather than choice of endpoint, explain the variation between studies of CRT in narrow‐QRS heart failure addressing physiological variables. When bias‐resistance features are implemented, it becomes clear that these patients do not improve in any tested physiological variable. Guidance from studies without careful planning to resist bias may be far less useful than commonly perceived.

Impact of mindfulness training on avoidant coping and advance care planning.

86 Background: Timely end-of-life (EOL) discussions and advance care planning (ACP) are crucial to quality cancer care; however, patients, family caregivers (CGs), and oncologists often avoid these tender conversations. When EOL discussions are avoided, patients are more likely to receive non-beneficial treatment near death and CGs are more likely to experience psychiatric disturbance. Mindfulness meditation facilitates emotional regulation and may enhance adaptive coping necessary for EOL discussions and ACP. Methods: Mindfully Optimizing Delivery of End-of-Life (MODEL) Care is a within-group pilot study developed to train patients with advanced-stage solid malignancies and their CGs (n=13 dyads) in present-moment awareness and non-reactive coping through a variety of mindfulness practices. Eligible patients met a threshold for avoidant coping and had not completed a Physician Orders for Scope of Treatment (POST) form documenting care preferences. Cognitive avoidance and quality of life (QoL) for patients and CGs were assessed from baseline (T1) to post-intervention (T2) and 1-month follow-up (T3) with standardized response mean (SRM) effect sizes. ACP from T1 to T3 was assessed descriptively. Results: Moderate decreases in cancer-related avoidance were found for patients (SRM=-0.47) and CGs (SRM=-0.59) T1 to T2, while T1 to T3 effects were small for patients (SRM=-0.31) and large for CGs (SRM=-1.12). At T1, no patient had completed a POST form; by T3, 50% reported completing one and 40% were preparing to do so soon. At T1, 23% of patients reported having had a ‘goals of care’ discussion with their oncologist, with 82% doing so by T3. At T1, 46% of patients reported having discussed ‘goals of care’ with their CGs, with 100% doing so by T3. Large improvements in QoL were found at both time points for patients and CGs (SRMs ranging from 0.85 to 1.21). Conclusions: Mindfulness was associated with mostly moderate reductions in avoidant coping and large improvements in QoL for patients and caregivers, with notable ACP progress for patients.

Do Manual Therapies Help Low Back Pain? A Comparative Effectiveness Meta-analysis

Meta-analysis methodology was extended to derive comparative effectiveness information on spinal manipulation for low back pain. Determine relative effectiveness of spinal manipulation therapies (SMTs), medical management, physical therapies, and exercise for acute and chronic nonsurgical low back pain. Results of spinal manipulation treatments of nonsurgical low back pain are equivocal. Nearly 40 years of SMT studies were not informative. Studies were chosen on the basis of inclusion in prior evidence syntheses. Effect sizes were converted to standardized mean effect sizes and probabilities of recovery. Nested model comparisons isolated nonspecific from treatment effects. Aggregate data were tested for evidential support as compared with shams. Of 84% acute pain variance, 81% was from nonspecific factors and 3% from treatment. No treatment for acute pain exceeded sham's effectiveness. Most acute results were within 95% confidence bands of that predicted by natural history alone. For chronic pain, 66% of 98% was nonspecific, but treatments influenced 32% of outcomes. Chronic pain treatments also fit within 95% confidence bands as predicted by natural history. Though the evidential support for treating chronic back pain as compared with sham groups was weak, chronic pain seemed to respond to SMT, whereas whole systems of clinical management did not. Meta-analyses can extract comparative effectiveness information from existing literature. The relatively small portion of outcomes attributable to treatment explains why past research results fail to converge on stable estimates. The probability of treatment superiority matched a binomial random process. Treatments serve to motivate, reassure, and calibrate patient expectations--features that might reduce medicalization and augment self-care. Exercise with authoritative support is an effective strategy for acute and chronic low back pain.

A Meta-Analytic Review of Graphic Organizers and Science Instruction for Adolescents with Learning Disabilities: Implications for the Intermediate and Secondary Science Classroom

This article presents a meta-analysis of experimental and quasi-experimental studies in which intermediate and secondary students with learning disabilities were taught science content through the use of graphic organizers (GOs). Following an exhaustive search for studies meeting specified selection criteria, 23 standardized mean effect sizes were extracted from six articles involving 271 participants in grades 6 through 12. Findings included that, across immediate posttest and maintenance conditions, the use of GOs was associated with increased vocabulary knowledge and factual comprehension measured by researcher-generated multiple-choice tests in science. Conclusions, implications for future research, and practical recommendations are presented.

Effectiveness of Computer-Assisted Instruction in Statistics

Although previous meta-analyses have documented the efficacy of computer-assisted statistics instruction, the current study examined a range of specific features that presumably influence its effectiveness, such as the level of learner engagement, learner control, and the nature of feedback. In 45 experimental studies with a control condition, computer-assisted statistics instruction provided a meaningful average performance advantage ( d = 0.33). Because of great methodological heterogeneity among the studies, the authors employed a conservative but appropriate mixed effects model to examine potential moderator effects. The authors’ analyses revealed three statistically significant findings. Larger effects were reported in studies in which treatment groups received more instructional time than control groups, in studies that recruited graduate students as participants, and in studies employing an embedded assessment. A newly developed second order standardized mean effect size, d diff, reveals that additional study characteristics may serve as meaningful moderators. Tight experimental control is needed to assess the importance of specific instructional features in computer-assisted statistics instruction.