Weighted Mean Effect Size Research Articles

Hypnosis and the Alleviation of Clinical Pain: A Comprehensive Meta-Analysis

ABSTRACT This is the first comprehensive meta-analysis in approximately 20 years of all controlled studies of the use of hypnosis for relieving clinical pain. To be included, studies were required to utilize a between-subjects or mixed model design in which a hypnosis intervention was compared with a control condition in alleviating any form of clinical pain. Of 523 records screened, 42 studies incorporating 45 trials of hypnosis met the inclusion criteria. Our most conservative estimates of the impact of hypnosis on pain yielded mean weighted effect sizes of 0.60 (p ≤ .001) for 40 post trials and 0.61 (p ≤ .001) for 9 follow-up trials. These effect sizes fall in the medium range according to Cohen’s guideline and suggest the average participant receiving hypnosis reduced pain more than about 73% of control participants. Hypnosis was moderated by the overall methodological quality of trials—the mean weighted effect size of the 19 post trials without high risk ratings on any of the Cochrane Risk of Bias dimensions was 0.77 (p ≤ .001). Hypnosis was also moderated by hypnotic suggestibility, with 6 post trials producing a mean weighted effect size of r = 0.53 (p ≤ .001). Our findings strengthen the assertion that hypnosis is a very efficacious intervention for alleviating clinical pain.

Comparative Effectiveness of Training with Simulators Versus Traditional Instruction in Veterinary Education: Meta-Analysis and Systematic Review.

One of the greatest challenges in veterinary education is adequately preparing students with the clinical skills they need to be successful health care providers. Integration of simulators, devices used to represent real world phenomena under test conditions, into the veterinary curriculum can help address challenges to clinical instruction. The use of simulators in veterinary education is increasing; however, their effectiveness remains unclear. This meta-analysis seeks to synthesize the evidence for simulator training in veterinary education to provide a consensus of effect, guide the integration of simulators into the curriculum, and direct the development of future simulation-based research in veterinary medicine. A systematic search identified 416 potential manuscripts from which 60 articles were included after application of inclusion criteria. Information was extracted from 71 independent experiments. The overall weighted mean effect size for simulator training was g = 0.49 for the random-effects model. The outcome measures of knowledge, time, process, and product all produced statistically significant mean effect sizes favoring simulation (d = 0.41, 0.35, 0.70, 0.53, respectively). A moderator analysis revealed that study characteristics and instructional design features moderated the effectiveness of simulator training. Overall, the results indicate that simulator training in veterinary education can be effective for knowledge and clinical skill outcomes.

Contributions of biomass/solid fuel burning to blood pressure modification in women: A systematic review and meta-analysis.

Approximately 2½ billion people worldwide rely on solid/biomass fuel as fuel for cooking/heating the home. Environmental exposure to the smoke associated with biomass fuel burning has been associated respiratory diseases, cardiac disorders, and altered blood pressure. Therefore, a systematic review and meta-analysis was conducted to study this relationship across multiple studies. Searches were performed using PRISMA guidelines for articles using Web of Science, PubMed, Toxline, and Web of Science of peer reviewed papers with no beginning time restriction until February 2017. The search yielded 10 manuscripts after application of inclusion criteria, which encompassed 93 724 participants. Outcomes included (a) the proportion of people with a clinical diagnosis of hypertension in an exposed (vs. unexposed) population or (b) correlation coefficients examining degree of exposure and systolic/diastolic blood pressure. The four studies reporting effect sizes for hypertension (N=92 042) had a weighted mean effect size of r=.12 [-0.02, 0.27], z=1.66, p=0.097. The six studies reporting effect sizes for systolic and diastolic blood pressure (N=1682) had weighted mean effect sizes of r=.15 [0.06, 0.24], p=0.001, and r=.09 [0.03, 0.15], p=0.002, respectively. These analyses revealed that there is a small-but-significant relationship between biomass fuel exposure and an increase in both systolic and diastolic blood pressure, but the relationship between biomass fuel and hypertension specifically remains unclear.

Medical students attitudes toward and intention to work with the underserved: a systematic review and meta-analysis

BackgroundExperts in the field of medical education emphasized the need for curricula that improve students’ attitudes toward the underserved. However, some studies have shown that medical education tends to worsen these attitudes in students. We aimed at systematically reviewing the literature assessing the change in medical students’ attitudes toward the underserved and intention to work with the underserved throughout medical education, the sociodemographic and educational factors associated with favorable medical student attitudes toward and/or intention to work with the underserved and the effectiveness of educational interventions to improve medical student attitudes toward and/or intention to work with the underserved.MethodWe conducted a systematic review on MEDLINE, Scopus, and Web of Science databases. Three investigators independently conducted the electronic search. We assessed the change in medical students attitudes toward the underserved by computing a weighted mean effect size of studies reporting scores from validated scales. The research team performed a meta-analysis for the sociodemographic and educational factors associated with medical students attitudes toward and/or intention to work with the underserved.ResultsFifty-five articles met the inclusion criteria, including a total of 109,647 medical students. The average response rate was 73.2%. Most of the studies were performed in the USA (n = 45). We observed a significant decline of medical students attitudes toward the underserved throughout medical education, in both US and non-US studies. A moderate effect size was observed between the first and fourth years (d = 0.51). Higher favorable medical students attitudes toward or intention to work with the underserved were significantly associated with female gender, being from an underserved community or ethnic minority, exposure to the underserved during medical education and intent to practice in primary care. Regarding educational interventions, the effectiveness of experiential community-based learning and curricula dedicated to social accountability showed the most positive outcome.ConclusionsMedical students attitudes toward the underserved decline throughout medical education. Educational interventions dedicated to improving the attitudes or intentions of medical students show encouraging but mixed results. The generalizability of our results is impeded by the high number of studies from the global-North included in the review.

Current Evidence for Nutrition Intervention: A Meta-analysis

Although different combinations of nutrition interventions are employed, most are insufficient to reduce stunting significantly. This study aimed to draw current evidence to reduce stunting among under 5 years children from randomized controlled trials. Eligible randomized controlled trials met inclusion criteria were included. The weighted mean effect sizes with 95% CIs were used as summary measures for changes in height-for-age z score (HAZ) using random-effect models; heterogeneity was analyzed using predefined characteristics. From the total of 116 articles, 47 randomized controlled trials with a sample size of 35,115 study participants were included for analysis. Except for educational intervention (0.14; 95%CI: 0.00, 0.27), the weighted mean effects of iron, zinc, water, sanitation and hygiene (WASH), multiple micronutrients (MMN) and dietary interventions were all insignificant. A fixed combination of nutrition interventions demonstrating similar benefit in all contexts is not found. Our results are insufficient to make a recommendation on the most appropriate interventions to reduce stunting in all settings. This result highlights the importance of further evidence before nutrition component formulation for large-scale interventions. The short duration of the interventions and lack of information about the infection status of participants in most of the included trials remain two of the possible limitations needing consideration.

Measures Matter: A Meta-Analysis of the Effects of Educational Apps on Preschool to Grade 3 Children’s Literacy and Math Skills

Thousands of educational apps are available to students, teachers, and parents, yet research on their effectiveness is limited. This meta-analysis synthesized findings from 36 intervention studies and 285 effect sizes evaluating the effectiveness of educational apps for preschool to Grade 3 children and the moderating role of methodological, participant, and intervention characteristics. Using random effects meta-regression with robust variance estimation, we summarized the overall impact of educational apps and examined potential moderator effects. First, results from rigorous experimental and quasi-experimental studies yielded a mean weighted effect size of +0.31 standard deviations on overall achievement and comparable effects in both math and literacy. Second, the positive overall effect masks substantial variability in app effectiveness, as meta-regression analyses revealed three significant moderators of treatment effects. Treatment effects were larger for studies involving preschool rather than K–3 students, for studies using researcher-developed rather than standardized outcomes, and for studies measuring constrained rather than unconstrained skills.

A Meta-Analytic Investigation of the Association Between Working Alliance and Outcomes of Individual Career Counseling

This article reports on the results of the first meta-analysis of the association between working alliance and outcomes of individual career counseling. This random-effects meta-analysis included 18 published and unpublished studies that produced a weighted mean effect size of r = .42. This effect size was heterogeneous across studies. Separate meta-analyses were conducted for several types of outcomes: Career outcomes, mental health outcomes, and client-perceived quality of the intervention. Average effect sizes for the association between working alliance and types of outcomes were .28, .18 and .62, respectively. Moderator analyses indicated that the overall mean effect size ( r =.42) varied in a large proportion as a function of the type of outcomes and the time of assessment of working alliance (first session, mid or at termination of the counseling service). Our results confirm that working alliance is associated to career counseling effectiveness and suggest that career counselors should emphasize on the working alliance during the career counseling process. In conclusion, this article provides suggestions for practice in individual career counseling and avenues of research on working alliance in this context.

The link between masculinity ideologies and posttraumatic stress: A systematic review and meta-analysis.

Masculinity ideologies have been associated with negative mental health outcomes. However, little is known regarding the link between masculinity ideologies and posttraumatic stress (PTS). This review aims to provide insight into this association by synthesizing available empirical research. The databases Web of Science, PsycINFO, and PubPsych were systematically searched for quantitative studies published up to 2018 in English language reporting on the association between masculinity ideologies and PTS. Results were narratively reviewed and synthesized in a multilevel meta-analysis. Eleven studies were included in the narrative review, while 10 studies provided effect sizes that were included in the meta-analysis. Samples mainly consisted of male veterans. The weighted mean effect size of the association between masculinity ideologies and PTS was r = .22. Studies including a clearly identifiable sample of trauma survivors reported a significantly smaller association than studies that did not specify the occurrence of a traumatic event. A narrative review of results showed that masculinity ideologies prescribing restrictive emotionality were more strongly associated with PTS relative to other masculine norms. Findings were limited regarding the influence of race and gender. The results suggest that interventions aimed at trauma survivors may benefit from addressing deficits in emotion regulation resulting from masculinity ideologies. However, more research is needed to understand how masculinity ideologies and PTS interact with conditions such as trauma type, gender, or race. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Effects of extracorporeal magnetic stimulation on urinary incontinence: A systematic review and meta-analysis.

To examine the effectiveness of extracorporeal magnetic stimulation for treatment of stress urinary incontinence. Systematic review and meta-analysis. Four electronic databases from inception to 18 May 2019. Two authors independently performed the search, assessed the methodological quality, and extracted data. The final studies included in the analysis were selected after reaching consensus with the third author. A total of 20 studies were included in the systematic review and 12 of these in the meta-analysis. Quality assessment indicated that only 8 of 17 randomized controlled trials had low risk in overall risk of bias, whereas all controlled trials had serious risk of bias. The weighted mean effect size of magnetic stimulation on quality of life, number of leakages, pad test outcomes, and number of incontinence events was 1.045 (95% CI: 0.409-1.681), -0.411 (95% CI: 0.178-0.643), -0.290 (95% CI: 0.025-0.556), and -0.747 (95% CI: -1.122 to -0.372), respectively. Subgroup analysis revealed a significant difference in the type of quality of life measurement used. Sensitivity analyses revealed that a high degree of heterogeneity persisted even after omitting studies individually. Extracorporeal magnetic stimulation may be effective in treating urinary incontinence and improving quality of life without major safety concerns. However, because of a high degree of heterogeneity among studies, inferences from the results must be made with caution. We recommend that clinical nurses apply extracorporeal magnetic stimulation to treat stress urinary incontinence among female patients and encourage researchers to conduct further qualitative and quantitative studies to develop consistent content and dosage for the intervention. The review protocol was registered a priori and published online in the PROSPERO database of systematic reviews (www.crd.york.ac.uk/Prospero with the registration number #CRD42019138835).

Differentiated Literacy Instruction: Boondoggle or Best Practice?

With increasingly diverse students, schools and districts are under pressure to meet rigorous standards and raise student achievement in reading and literacy. Most teachers respond by differentiating their instruction to some extent, but not all scholars and educators agree on whether differentiated instruction works. This systematic review and meta-analysis seeks to determine the effects of Tier 1 differentiation, which is provided by the general education classroom teacher, on literacy outcomes. Distinguishing between designed differentiation and interactional differentiation, the authors provide multiple examples of content, process, and product differentiation in the context of literacy instruction. Reviewing more than 20 years of literacy research, the authors located 18 studies with 25 study cohorts. Outcomes include fluency, decoding, letter-word reading, vocabulary, comprehension, and writing achievement. The overall weighted mean effect size (g) was +0.13 (p = .002) with 88% of the individual point estimates being positive. Overall, the findings indicate that differentiated literacy instruction is an effective evidence-based practice at the elementary level. When teachers are supported to differentiate instruction, students have significantly higher literacy achievement scores, particularly for letter-word (g = +0.20, p = .014) and writing outcomes (g = +0.96, p < .001). The most successful programs took very different approaches to differentiation, including individualization, choice, and an alternate curriculum. However, across the studies, there was an alarming lack of information about the decision-making processes used to guide differentiation and there were no experimental or quasi-experimental studies on guided reading. This review may be helpful as schools clarify their vision for literacy differentiation.

A meta-analysis of wearables research in educational settings published 2016–2019

The integration of wearables in education environments to enhance teaching and learning is an emerging area of research. However, many studies lack the rigor of formal research designs and results are inconclusive. The purpose of this meta-analysis was to examine the overall effect of wearable use on learning and motivation outcomes and describe the characteristics of the studies that comprise the body of quantitative wearables research. Searches for wearables research were conducted in three databases resulting in 144 results with duplicates removed. Coding based on specific inclusion criteria resulted in 12 studies with 20 effect sizes published between January 2016 and August 2019. The overall weighted mean effect size for 20 learning and motivation outcomes was .6373 (SE = .1622). It should be noted that while this result was statistically significant (z = 3.9292, p = .0001) with 95% CI [.3194, 9552], the heterogeneity was also statistically significant. Additional weighted mean effect sizes relating to study characteristics were significant while meeting the assumption of homogeneity. A discussion of the findings, implications, and limitations are provided.

Leftover opioids following adult surgical procedures: a systematic review and meta-analysis

BackgroundUS opioid prescribing and use escalated over the last two decades, with parallel increases in opioid misuse, opioid-related deaths, and concerns about diversion. Postoperatively prescribed opioids contribute to these problems. Policy makers have addressed this issue by limiting postoperative opioid prescribing. However, until recently, little data existed to guide prescribers on opioid needs postoperatively. This meta-analysis quantitatively integrated the growing literature regarding extent of opioids leftover after surgery and identified factors associated with leftover opioid proportions.MethodsWe conducted a meta-analysis of observational studies quantifying postoperative opioid consumption in North American adults, and evaluated effect size moderators using robust variance estimation meta-regression. Medline, EMBASE, Cumulative Index of Nursing and Allied Health Literature, and Cochrane Database of Systematic Reviews were searched for relevant articles published January 1, 2000 to November 10, 2018. The Methodological Index for Non-Randomized Studies (MINORS) tool assessed risk of study bias. The proportion effect size quantified the primary outcome: proportion of prescribed postoperative opioids leftover at the time of follow-up. Primary meta-regression analyses tested surgical type, amount of opioids prescribed, and study publication year as possible moderators. Secondary meta-regression models included surgical invasiveness, age, race, gender, postoperative day of data collection, and preoperative opioid use.ResultsWe screened 911 citations and included 44 studies (13,068 patients). The mean weighted effect size for proportion of postoperative opioid prescriptions leftover was 61% (95% CI, 56-67%). Meta-regression models revealed type of surgical procedure and level of invasiveness had a statistically significant effect on proportion of opioids leftover. Proportion of opioids leftover was greater for “other soft tissue” surgeries than abdominal/pelvic surgeries, but did not differ significantly between orthopedic and abdominal/pelvic surgeries. Minimally invasive compared to open surgeries resulted in a greater proportion of opioids leftover. Limitations include predominance of studies from academic settings, inconsistent reporting of confounders, and a possible publication bias toward studies reporting smaller leftover opioid proportions.Conclusions and implications of key findingsA significant proportion of opioids are leftover postoperatively. Surgery type and level of invasiveness affect postoperative opioid consumption. Integration of such factors into prescribing guidelines may help minimize opioid overprescribing while adequately meeting analgesic needs.

Multidimensional Perfectionism and Test Anxiety: a Meta-analytic Review of Two Decades of Research

Over the past 20 years, many studies have shown that students’ test anxiety is significantly related to their level of perfectionism. However, the reported results are relatively inconsistent, varying in both the magnitude and direction of relationships. The present study provides the first meta-analytic review of the relationships between multidimensional perfectionism and test anxiety, integrating 92 effect sizes from 22 samples (N = 4521). The results revealed that perfectionistic concerns showed a moderate to strong positive association with overall test anxiety (r+ = .42), whereas perfectionistic strivings presented a small positive but nonsignificant relationship with overall test anxiety (r+ = .04). However, perfectionistic concerns and strivings both displayed significant positive correlations with cognitive and affective test anxiety. The weighted mean effect size for the relationship between perfectionistic strivings and overall test anxiety was affected by publication bias. After controlling for the overlap between the two dimensions of perfectionism, the association of perfectionistic concerns with overall test anxiety increased slightly, whereas the associations of both perfectionism dimensions with cognitive and affective test anxiety decreased. Moderation analyses indicated that the perfectionism subscale used had a significant influence on the relationships between perfectionistic dimensions and test anxiety. In addition, the year of publication played a moderating role in the association of perfectionistic concerns with test anxiety. The findings suggest that perfectionistic concerns might share common cognitive manifestations with overall and cognitive test anxiety.

The Role of Public Defenders Within the American Justice System

This paper examines the inner workings of the legal system in connection with public defenders and their duties. The factors of total caseload, plea deals, waivers, and bench verdicts were implemented to create a comprehensive means of measuring work ethic, due to their significant presence in the everyday workings of public defenders. Through a meta-analysis of the five most densely populated African American cities within the state of Michigan, the combined and individual weighted mean effect sizes were calculated to determine if there was a strong positive or negative effect of the four factors mentioned above on work ethic. Additionally, both the upper and lower credibility levels were calculated to analyze their proximity to the weighted means. For all four factors tested, the weighted mean effect sizes relate a positive effect of the factors on work ethic, with all means falling closer to their upper credibility levels. These results confirm that the factors of total caseload, plea deals, waivers, and bench verdicts affect how cases are being handled and how clients are being treated.

Revisiting the Empirical Status of Social Learning Theory on Substance Use: A Systematic Review and Meta-Analysis

Background: Despite ample empirical research testing components of Akers’ Social Learning Theory (SLT) on substance use, no research to date has attempted to synthesize the empirical evidence. Objectives: The purpose of this article is to synthesize prior research that has examined the utility of SLT for predicting specific types of substance use, both legal and illegal. Methods: Using a systematic review and meta-analysis, the current study estimated the effect size results from 83 primary studies published between 1974 and 2018 that had empirically tested concepts of Akers’ SLT regarding substance use. In addition, moderator analyses examined variations in effect sizes across measurement constructs and among specific types of substance use. Results: Results indicated medium-sized weighted mean effect size estimates for SLT in relation to substance use. Regarding conceptualization of SLT, measures of Differential Association produced the strongest effect size estimates. Moderator analyses also revealed that mean effect size estimates were largest for soft drugs, for studies conducted in the context of the United States, and for adult samples. Conclusions: The authors conclude that SLT constructs may be better suited for explaining soft drug use than hard drug use. Given the relatively sparse primary research that has controlled for temporal ordering, collected data from multiple differential associates, or considered opportunity effects, caution in the interpretation of synthesis results is warranted.

Effects of Accumulated Short Bouts of Exercise on Weight and Obesity Indices in Adults: A Meta-Analysis.

To compile and quantify the effectiveness of accumulated short-bout exercise interventions on reducing the obesity indices in adults using meta-analysis. PubMed, PsycINFO, CINAHL, Cochrane Library, and SportDiscus. (1) Description of a short-bout exercise trial (<30 minutes); (2) obesity indices must be measured pre- and postintervention; and (3) only adults and published in English. Two independent reviewers extracted data and assessed the quality of the studies included. Of 3257 articles retrieved, 18 studies met the inclusion criteria. Based on the Downs and Black checklist, the methodological quality of the included studies was fairly robust. Pooled effect sizes (ESs) were calculated using a random effects model. Average intervention length was approximately 16 weeks (ranged from 4 to 72 weeks). All weighted mean ES values for each obesity index measure were non-negative, ranging from small to large (ES = 0.33-0.96) in magnitude. Weighted mean ES for body mass (BM; n = 18; ES = 0.51, 95% confidence interval [CI] = 0.22-0.80), body mass index (BMI; n = 13; ES = 0.61, 95% CI = 0.24-0.97), waist circumference (n = 9; ES = 0.44, 95% CI = 0.15-0.73), body fat percentage (BF%; n = 8; ES = 0.33, 95% CI = 0.09-0.58), skinfold (n = 7; ES = 0.96, 95% CI = 0.39 -1.53), and fat mass (FM; n = 6; ES = 0.55, 95% CI = 0.21-0.90) were statistically significant. Moderator effects of intervention length (weeks) were observed for BM (Qbetween [Cochran's Q: a measure of heterogeneity between studies] = 6.83, P < .05); BMI (Qbetween = 13.93, P < .05); and FM (Qbetween = 10.41, P < .05). Intervention length >10 weeks was more effective than shorter (≤10) intervention period for reducing BM, BMI, and FM. Accumulated short bouts of exercise have a beneficial effect on reducing the obesity indices among adults. The current study can help health researchers and practitioners in designing their intervention programs, which can be applied within schools, clinics, and communities.

An update on the efficacy of anti-inflammatory agents for patients with schizophrenia: a meta-analysis

Accumulating evidence shows that a propensity towards a pro-inflammatory status in the brain plays an important role in schizophrenia. Anti-inflammatory drugs might compensate this propensity. This study provides an update regarding the efficacy of agents with some anti-inflammatory actions for schizophrenia symptoms tested in randomized controlled trials (RCTs). PubMed, Embase, the National Institutes of Health website (http://www.clinicaltrials.gov), and the Cochrane Database of Systematic Reviews were systematically searched for RCTs that investigated clinical outcomes. Our search yielded 56 studies that provided information on the efficacy of the following components on symptom severity: aspirin, bexarotene, celecoxib, davunetide, dextromethorphan, estrogens, fatty acids, melatonin, minocycline, N-acetylcysteine (NAC), pioglitazone, piracetam, pregnenolone, statins, varenicline, and withania somnifera extract. The results of aspirin [mean weighted effect size (ES): 0.30; n = 270; 95% CI (CI) 0.06-0.54], estrogens (ES: 0.78; n = 723; CI 0.36-1.19), minocycline (ES: 0.40; n = 946; CI 0.11-0.68), and NAC (ES: 1.00; n = 442; CI 0.60-1.41) were significant in meta-analysis of at least two studies. Subgroup analysis yielded larger positive effects for first-episode psychosis (FEP) or early-phase schizophrenia studies. Bexarotene, celecoxib, davunetide, dextromethorphan, fatty acids, pregnenolone, statins, and varenicline showed no significant effect. Some, but not all agents with anti-inflammatory properties showed efficacy. Effective agents were aspirin, estrogens, minocycline, and NAC. We observed greater beneficial results on symptom severity in FEP or early-phase schizophrenia.

The Efficacy of Hypnosis as a Treatment for Anxiety: A Meta-Analysis

This meta-analysis quantifies the effectiveness of hypnosis in treating anxiety. Included studies were required to utilize a between-subjects or mixed-model design in which a hypnosis intervention was compared with a control condition in alleviating the symptoms of anxiety. Of 399 records screened, 15 studies incorporating 17 trials of hypnosis met the inclusion criteria. At the end of active treatment, 17 trials produced a mean weighted effect size of 0.79 (p ≤ .001), indicating the average participant receiving hypnosis reduced anxiety more than about 79% of control participants. At the longest follow-up, seven trials yielded a mean weighted effect size of 0.99 (p ≤ .001), demonstrating the average participant treated with hypnosis improved more than about 84% of control participants. Hypnosis was more effective in reducing anxiety when combined with other psychological interventions than when used as a stand-alone treatment.

Parental supervision and later offending: A systematic review of longitudinal studies

Abstract Parental supervision has been identified as an important influence on offending. This systematic review focuses specifically on parental supervision, compared to existing systematic reviews which tend to concentrate on a wider range of family factors. The main aim of this article is to assess the precise nature of the association between parental supervision and offending. Overall, 19 prospective longitudinal studies were identified (published since 1996) which met the inclusion criteria. The results show a weighted mean effect size (ES) of Cohen's d = 0.37 between parental supervision and later offending. This review discovered that studies use different types of behavior to define parental supervision. Interestingly, a larger weighted mean effect size (d = 0.45) was found for studies measuring ‘level of parental knowledge’ compared to studies measuring ‘child disclosure to parents’ (d = 0.33) or ‘parental rule setting’ (d = 0.14). The results suggest that the strength of social bonds is important for enabling parents to maintain high levels of knowledge. Prevention programs should aim to develop robust channels of communication that increase parental knowledge regarding the activities of their children. Future research should also clarify the definition of parental supervision, in order to make it possible to compare different studies of parenting.

Parameters and Effects of Photobiomodulation in Plantar Fasciitis: A Meta-Analysis and Systematic Review.

Objective: This systematic review and meta-analysis updated the effects of photobiomodulation therapy (PBMT) on pain, the Foot Function Index (FFI), and the effects on fascial thickness in adults with acute or chronic plantar fasciitis (PF). Methods: A systematic literature search was conducted in the PubMed (Public/Publisher MEDLINE), EMBASE (Excerpta Medica Database), and CINAHL (Cumulative Index to Nursing and Allied Health Literature) databases. Two researchers independently screened titles and abstracts of the retrieved studies for eligibility. A random-effects model was used for this meta-analysis. Subgroup meta-analyses were conducted to evaluate the influence of PBMT in pain and foot function under investigation and the study design on the overall weighted mean effect size. Results: From a total of 3865 studies, 7 randomized controlled trials were selected after final review and 4 were selected for meta-analysis. There was a significant difference between PBMT and control for Visual Analog Scale (Chi2 = 29.30; p < 0.00001) with an I2 value of 90% in favor of PBMT versus the control. The overall effect of PBMT was statistically significant (p < 0.02) with PBMT favoring for thickness of the plantar fascia reduction. FFI between PBMT and control group [Chi2 -83.46, df = 1 (p < 0.00001)]; I2 = 99% in favor of the PBMT. Conclusions: This meta-analysis presents evidence that PBMT is an effective treatment modality to reduce pain and improvement of foot function in patients with chronic PF, however, a broad discrepancy was found in the PBMT dosimetry. The ideal treatment parameters for PF need to be elucidated.