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Nyssen OP, Taylor SJC, Wong G, et al. Does therapeutic writing help people with long-term conditions? Systematic review, realist synthesis and economic considerations. Southampton (UK): NIHR Journals Library; 2016 Apr. (Health Technology Assessment, No. 20.27.)

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Does therapeutic writing help people with long-term conditions? Systematic review, realist synthesis and economic considerations.

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Appendix 5Characteristics of included studies

Study design

TABLE 98

Study design of included studies

First author, yearCountryStudy designn of intervention groupsn of control groups
Abel 200450USARCT11
Arden-Close 201380UKRCT11
Averill 2013100USARCT11
Bartasiuniene 2011102LithuaniaRCT12
Bernard 200693UKRCT11
Broderick 2004113USARCT21
Broderick 2005118USARCT11
Canna 200694USARCT22
Cepeda 200885ColombiaRCT12
Craft 201374USARCT22
Dennick 201488UKRCT11
D’Souza 2008101USARCT11
Gellaitry 201075UKRCT11
Gidron 199698IsraelRCT11
Gillis 2006119USARCT11
Golkaramnay 200768GermanyControlled cohort11
Graf 200895USARCT11
Graham 200851USARCT11
Grasing 201090USARCT11
Halpert 201052USAControlled cohort11
Hamilton-West 2007114UKRCT11
Harris 2005106USARCT21
Henry 201053USACase–control11
Hevey 2012103IrelandRCT11
Hong 201167KoreaRCT11
Hughes 200754USARCT11
Ironson 201371USARCT11
Jensen-Johansen 201376DenmarkRCT11
Kraaij 201055NetherlandsRCT11
Krpan 201396USARCT11
Lange 200369NetherlandsRCT11
Lumley 2011115USARCT21
Lumley 2014116USARCT22
Mann 200172USARCT11
McElligott 200687USANon-RCT11
Meshberg-Cohen 201091USARCT11
Milbury 201481USARCT11
Mosher 201277USARCT11
Paradisi 2010110ItalyRCT21
Park 201278KoreaControlled cohort11
Pauley 201182USARCT21
Petrie 200456New ZealandRCT11
Richards 200097USARCT12
Rickett 201166AustraliaRCT11
Rini 201486USARCT31
Robinson 200899UKRCT11
Rosenberg 200283USARCT11
Sharifabad 2010105USARCT11
Sloan 201270USARCT11
Smyth 1999107USARCT11
Smyth 2008121USARCT11
Stark 201057USARCT31
Tabolli 2012111ItalyRCT11
Taylor 200389USARCT11
Theadom 201058UKRCT11
Van Dam 201392NetherlandsRCT11
Vedhara 2007112New ZealandRCT11
Wagner 201073USARCT11
Walker 199979USARCT21
Wallander 2011109USARCT11
Warner 2006108USARCT11
Wetherell 2005117UKRCT11
Willmott 2011104UKRCT11
Zakowski 200484USARCT11

Participants’ conditions

TABLE 99

Long-term conditions, ICD-10 codes and diagnostic criteria used at study entry in included studies

First author, yearLTCICD-10 codeLTC: inclusion criteria/diagnostic tool(s)
Abel 200450HIVB24Taking ART for their diagnosis, able to report their last VL of < 80 000–100,000 copies/ml, free of major psychiatric problems (self-report)
Arden-Close 201380Ovarian cancerC56Disease stage from I to IV, with CA125 level checked by oncologist and categorised above or below 35 U/ml for the prognosis of the cancer and within 5 years of treatment
Averill 2013100ALSG12Definite or probable ALS using El Escorial criteria at least 6 months prior to study entry (World Federation of Neurology Research Group on Neuromuscular Diseases, 1994); FVC in the 50th percentile or higher
Bartasiuniene 2011102CVDI51
Bernard 200693PTSDF43First episode of psychosis conforming to broad ICD-10 criteria (F20, F22, F23, F25)
Broderick 2004113RAM06Formal diagnosis of RA
Broderick 2005118FMM79Formal diagnosis of FM by a physician
Canna 200694Axis I anxiety or mood disorderF41Individuals with axis I anxiety or mood disorder primary diagnosis
Cepeda 200885CancerC80Any type of cancer and reporting average pain intensity levels of at least 5/10 on a 0–10 scale; scored > 50% in the Karnofsky scale
Craft 201374Breast cancerC50Invasive or non-invasive early stage breast cancer, definitive treatment (surgery, chemotherapy and/or radiation therapy) completed, time from diagnosis < 2 years
Dennick 201488Type 2 diabetes mellitusE11
D’Souza 2008101Tension/migraine headachesG43/G44International Headache Society criteria for either tension or migraine headaches
Gellaitry 201075Breast cancerC50Patients with early-stage breast cancer, attending the last radiotherapy appointment at the outpatient clinic and without a defined psychiatric disorder
Gidron 199698PTSDF43PTSD assessed with the Mississippi Scale for PTSD
Gillis 2006119FMM79Rehabilitation hospital patients with CVD
Golkaramnay 200768Mental disordersF41–F60Inpatient from hospital with mental health conditions according to the ICD-10 criteria
Graf 200893Psychiatric disorderF99Participants from an university-based outpatients’ psychiatric clinic and student counselling centre
Graham 200851Chronic painUnclassifiablePatients had experience for at least 6 months and were recruited during routine visits to a university hospital-affiliated outpatient pain centre
Grasing 201090Cocaine dependenceF14Meeting DSM-IV criteria for cocaine dependence at the time of admission
Halpert 201052IBSK58Fulfilled the Rome III Criteria for IBS
Hamilton-West 2007114ASM45Inflammation of the joints in the pelvis; low back pain and stiffness for > 3 months, which improves with exercise but is not relieved by rest; limited movement of the lower back and restricted chest expansion
Harris 2005106AsthmaJ45Asthma was confirmed by a history of asthma diagnosed by a physician and either evidence of reduced expiratory volume and reversibility obtained through medical records or evidence of reduced expiratory volume evaluated by study staff
Henry 201053Breast cancerC50Female breast cancer survivors attending radiation oncology clinics
Hevey 2012103MII21Patients with confirmed MI, who received treatment at a large teaching hospital
Hong 201167Dementia (Alzheimer’s disease/vascular dementia/Parkinson’s disease)F03 (F00/F01/F02)Elderly people housed in a nursing home and already medically diagnosed with dementia, and scoring ≤ 19 on the MMSE-K
Hughes 200754Breast cancerC50Stage I, II or III breast cancer women receiving curative radiation therapy for breast cancer
Ironson 201371HIV (plus PTSD)B24 (plus F43)HIV-positive, falling into a CD4 range of 100–600. Included were also those with one Category C symptom (AIDS defining) but without C symptoms 1 year prior to study entry. The stress of HIV was considered sufficient to enter the study and no other trauma was required
Jensen-Johansen 201376Breast cancerC50Female Danish residents, able to read and write Danish, aged 18–70 years, and treated surgically within 3 weeks of their diagnosis (mastectomy or lumpectomy) for invasive breast cancer, stages I and II
Kraaij 201055HIVB24HIV-diagnosed patients. No restricted criteria regarding the VL or the CD4+ count
Krpan 201396DepressionF41According to SCID
Lange 200369PTSDF43Participants had to score below the cut-off scores of the Depression subscale of the SCL-90 in the Dutch norm, the SDQ-5, and the Dutch Screening Device for Psychotic Disorder of the Dutch norm group
Lumley 2011115RAM06Patients with RA who met American College of Rheumatology criteria for non-juvenile RA. Patients had to report experience pain or disability due to their RA in the preceding week
Lumley 2014116RAM06RA patients meeting American College of Rheumatology criteria for non-juvenile RA. Patients had to report experience pain or disability due to their RA in the preceding week
Mann 200172HIVB24Women being treated for HIV or diagnosed with AIDS
McElligott 200687Sickle cell diseaseD57Medically diagnosed with sickle cell disease
Meshberg-Cohen 201091SUDF19The Structured Clinical Interview for DSM-IV-TR – Alcohol and Substance Use Disorders Module (SCID) was used as the diagnostic interview assessing SUD diagnosis, including alcohol and other drugs
Milbury 201481RCCC64Newly diagnosed with stage I–IV RCC and with a Zubrod performance status of < 2
Mosher 201277Breast cancerC50Distressed women with stage IV breast cancer
Paradisi 2010110PsoriasisL40Plaque-type psoriasis involving > 10% of body area
Park 201278Breast cancerC50Stage II and III, breast cancer survivors, women. No restriction to staging, surgery or drugs intake
Pauley 201182Testicular cancerC62Testicular cancer survivors, men. No restriction to staging, surgery or drugs intake
Petrie 200456HIVB24Documented HIV infection and not had their classified oral drug regimen changed in the previous 12 months
Richards 200097Mental disorderF41–F60Diagnosed with at least one mental disorder, as classified with the DSM-III-R
Rickett 201166CancerC80All diagnosed with cancer except for one participant with a history of severe CVD, and one with an autoimmune disorder
Rini 201486Following stem cell transplantC80
Robinson 200899BNF50Diagnosis was made using information from the QEDD using DSM-IV (American Psychiatric Association, 1994) for definitions of disorders. Included were those with a diagnosis of BN (purging or non-purging)
Rosenberg 200283Prostate cancerC61Histological diagnosis of adenocarcinoma of the prostate being followed with serial PSAs. Previously local treatment (prostatectomy or radiation) within the last 4 years
Sharifabad 2010105COPD plus IPFJ44 plus J84Medically diagnosed with COPD or IPF
Sloan 201270PTSDF43Participants met DSM-IV PTSD Criterion A for a traumatic stressor (American Psychiatric Association, 1994)
Smyth 1999107Asthma/RAJ45/M06RA diagnosis was confirmed by board-certified rheumatologists and all patients met American College of Rheumatology criteria
Asthma was diagnosed by a history of asthma, confirmed by a physician; patients were also required to provide a documented reduction in expiratory function (either in physician records or when evaluated by study staff)
Smyth 2008121PTSDF43Based on PTSD diagnosis verification defined by the DSM-IV
Stark 201057FM plus facial painM79Diagnosis made by the referring physician
Tabolli 2012111PsoriasisL40Diagnosis by an experienced staff dermatologist, according to established internationally accepted criteria, with ≥ 10% of body surface affected
Taylor 200389Cystic fibrosisE84Medically diagnosed with cystic fibrosis
Theadom 201058AsthmaJ45Diagnosed with asthma and requiring regular inhaled medication (British Thoracic Society step 2 or higher; British Thoracic Society and Scottish Intercollegiate Guidelines Network, 2005)
Van Dam 201392SUDF14Diagnosed with SUD
Vedhara 2007112PsoriasisL40A clinically verified diagnosis of psoriasis for at least 6 months
Wagner 201073HIVB24Diagnosed with HIV only
Walker 199979Breast cancerC50Women completing radiation therapy for breast cancer stage I or II with a Karnofsky performance status of ≥ 70%
Wallander 2011109GI RAPR10Patients with GI RAP, who met Apley’s (1975) criteria for functional RAP as determined by a paediatric GI specialist
Warner 2006108AsthmaJ45Participants classified with mild, persistent asthma (i.e. asthma symptom activity at least 2 days per week and nocturnal symptoms at least twice monthly)
Wetherell 2005117RAM06Diagnosed with RA
Willmott 2011104MII21Participants were the first patients with MI who were receiving treatment at two acute hospital clinics
Zakowski 200484Prostate plus gynaecological cancerC61 (prostate) plus C55 (uterus), C56 (ovary), C53 (cervix)Participants with a first-time diagnosis of prostate or gynaecological cancer within the last 5 years

AIDS, acquired immunodeficiency virus; MMSE-K, Mini Mental State Examination Korean Version; PSA, prostate-specific antigen; SCL-90, Symptom Checklist-90; SDQ-5, somatoform dissociation questionnaire-5.

Included studies categorised by International Classification of Diseases, Tenth Edition code by the reviewers

TABLE 100

Included studies by ICD-10 code

First author, yearLTCICD-10 code
Abel 200450HIVB24
Kraaij 201055HIVB24
Mann 200172HIVB24
Petrie 200456HIVB24
Wagner 201073HIVB24
Ironson 201371HIV (plus PTSD)B24
Craft 201374Breast cancerC50
Gellaitry 201075Breast cancerC50
Henry 201053Breast cancerC50
Hughes 200754Breast cancerC50
Jensen-Johansen 201376Breast cancerC50
Mosher 201277Breast cancerC50
Park 201278Breast cancerC50
Walker 199979Breast cancerC50
Arden-Close 201380Gynaecological and genitourinary cancerC57 (ovarian)
Rosenberg 200283Gynaecological and genitourinary cancerC61(prostate)
Zakowski 200484Gynaecological and genitourinary cancerC61 (prostate) plus C55 (uterus), C56 (ovary), C53 (cervix)
Pauley 201182Gynaecological and genitourinary cancerC62 (testicular)
Milbury 201481Gynaecological and genitourinary cancerC64
Cepeda 200885Cancer from various sourcesC80
Rickett 201166Cancer from various sourcesC80
Rini 201486Cancer from various sourcesC80
McElligott 200687Sickle cell diseaseD57
Taylor 200389Cystic fibrosisE84
Hong 201167Dementia (Alzheimer’s disease/vascular dementia/Parkinson’s disease)F03 (F00/F01/F02)
Grasing 201090Cocaine dependenceF14
Meshberg-Cohen 201091SUDF19
Van Dam 201392SUDF19
Bernard 200693First episode psychosisF41–F60
Canna 200694Mental disorder (Axis I anxiety or mood disorder)F41–F60
Golkaramnay 200768Mental disorderF41–F60
Richards 200097Mental disorderF41–F60
Graf 200895Mental disorder (psychiatric disorder)F41–F60 (F99)
Krpan 201396DepressionF41
Gidron 199698PTSDF43
Lange 200369PTSDF43
Sloan 201270PTSDF43
Smyth 2008121PTSDF43
Robinson 200899BNF50
Averill 2013100ALSG12
D’Souza 2008101Tension/migraine headachesG43/G44
Hevey 2012103MII21
Willmott 2011104MII21
Bartasiuniene 2011102CVDI51
Sharifabad 2010105COPD plus IPFJ44 plus J84
Harris 2005106AsthmaJ45
Theadom 201058AsthmaJ45
Warner 2006108AsthmaJ45
aSmyth 1999107Asthma/RAJ45/M06
Halpert 201052IBSK58
Wallander 2011109IBS (GI RAP)K58 (R10)
Paradisi 2010110PsoriasisL40
Tabolli 2012111PsoriasisL40
Vedhara 2007112PsoriasisL40
Broderick 2004113RAM06
Lumley 2011115RAM06
Lumley 2014116RAM06
Wetherell 2005117RAM06
Hamilton-West 2007114ASM45
Broderick 2005118FMM79
Gillis 2006119FMM79
Stark 201057FMM79
Graham 200851Chronic painM79
a

Smyth et al.107 has been reported twice under J45 and M06/M45 ICD-10 categories.

Note that this table includes the studies classified as assessing an unfacilitated TW intervention.

Interventions assessed

Interventions assessed

TABLE 101

Intervention groups as described in included studies

First author, yearExperimental conditionControl condition
Intervention group 1Intervention group 2Control group 1Control group 2
Abel 200450EW disclosure (unfacilitated type of TW)Daily activities writing
Arden-Close 201380Written emotional disclosure (unfacilitated type of TW)Details of previous day writing
Averill 2013100Written or oral expressive disclosure (unfacilitated type of TW) plus completion of study measuresAttentional control writing (completion of study measures)
Bartasiuniene 2011102Expressive writing (unfacilitated type of TW)Daily events writingNon-writing group (wrote nothing)
Bernard 200693Written emotional disclosure (unfacilitated type of TW)Non-EW (activities that day, the room they were in, and plans for the next week)
Broderick 2004113Standard expressive writing (unfacilitated type of TW)Enhanced meaning writingDay-to-day activities in relation to the time investedEducational attention control group
Broderick 2005118Written emotional expression with cognitive reappraisalDay-to-day activities in relation to the time investedNon-writing (usual care)
Canna 200694Expressive writing plus CBTCBTInexpressive writing plus CBTWaiting list
Cepeda 200885Narrative emotional disclosureQuestionnaire writingUsual care
Craft 201374Breast-cancer trauma writing (unfacilitated type of TW)Self-selected trauma writing (unfacilitated type of TW)Breast cancer factual writing (unfacilitated type of TW)Non-writing
Dennick 201488Written emotional disclosurePrevious day’s activities
D’Souza 2008101Written emotional disclosure (unfacilitated type of TW)Time-management control writing
Gellaitry 201075Expressive writing (unfacilitated type of TW)Routine care
Gidron 199698Written disclosure (unfacilitated type of TW) plus oral disclosure of most severe eventCasual daily agenda writing plus oral disclosure of daily activity
Gillis 2006119Written emotional disclosure (unfacilitated type of TW)Time-management writing
Golkaramnay 200768Group therapy through internet chatNo intervention
Graf 200895Written emotional disclosure (unfacilitated type of TW)Plans for the rest of the day writing
Graham 200851Written anger expression through letter-writing format (Rusing and Nolen-Hoeksema type of TW)Goals writing through letter-writing format
Grasing 201090Written emotional expression (Pennebaker type of TW)Time-management writing
Halpert 201052Expressive writing (unfacilitated type of TW)Non-writing
Hamilton-West 2007114EW exercise (unfacilitated type of TW not approved by ethics committee – adapted version used)Time-management exercise
Harris 2005106Stressful experiences writingPositive writingNeutral topic writing
Henry 201053Positive expressive writing (single episode unfacilitated type of TW)Usual care
Hevey 2012103Expressive writing (single episode unfacilitated type of TW)Daily activities writing in the year prior to heart attack
Hong 201167SongwritingWaiting list
Hughes 200754Expressive writingUsual care
Ironson 201371Augmented trauma writing (unfacilitated type of TW) plus processing probesDaily event writing
Jensen-Johansen 201376Expressive writing (unfacilitated type of TW)Daily activities writing
Kraaij 201055Structured writing intervention (through website)Cognitive–behavioural self-help programmeWaiting list
Krpan 201396Expressive writing (deepest thoughts and feelings)How they organised their day
Lange 200369InterapyWaiting list
Lumley 2011115Written or oral emotional disclosurePositive writing (or talking)Neutral topic writing (or talking)
Lumley 2014116Expressive writing, coping skills trainingNeutral writing, coping skills training
Mann 200172Positive future writingNon-writing
McElligott 200687Expressive writing (unfacilitated type of TW)Details of previous day writing
Meshberg-Cohen 201091Expressive writing (unfacilitated type of TW)Neutral topic writing
Milbury 201481Expressive writing (unfacilitated type of TW)Neutral topic writing
Mosher 201272Expressive writingNeutral topic writing
Paradisi 2010110Written emotional disclosure (unfacilitated type of TW)Positive future writing (unfacilitated type of positive TW)Non-emotional disclosure
Park 201278Expressive writing programme (unfacilitated type of TW)No intervention
Pauley 201182Negative expressive writing (unfacilitated type of TW)Positive expressive writing (unfacilitated type of TW)Innocuous writing
Petrie 200456Written emotional expression (unfacilitated type of TW)Time-management writing
Richards 200097Trauma writing (unfacilitated type of TW)Trivial writingUsual routine
Rickett 201166Poetry writing programme/workshopWaiting list
Rini 201486Expressive writingPeer helping, expressive helpingNeutral writing
Robinson 200899eBTUnsupported SDW (unfacilitated type of TW)Waiting list
Rosenberg 200283Expressive writing (unfacilitated type of TW)Non-disclosure
Sharifabad 2010105Written emotional disclosure (unfacilitated type of TW)Neutral topic writing
Sloan 201270WETWaiting list
Smyth 1999107Disclosure exercise (unfacilitated type of TW)Neutral topic writing
Smyth 2008121Expressive writing (unfacilitated type of TW)Daily plans writing
Stark 201057Trauma writing (unfacilitated type of TW) plus Change Theory (King type of TW)Time management (factual writing)
Tabolli 2012111Writing exercise (unfacilitated type of TW)Non-writing
Taylor 200389Written self-disclosure intervention (unfacilitated type of TW)SMC
Theadom 201058Written emotional disclosure (unfacilitated type of TW)Details of previous day writing
Van Dam 201392Expressive writing (unfacilitated type of TW)Treatment as usual
Vedhara 2007112Written emotional disclosure (unfacilitated type of TW)Details of previous day writing
Wagner 201073Expressive writing (unfacilitated type of TW)Trivial writing
Walker 199979Single-episode written emotional expression (unfacilitated type of TW)Three-episode written emotional expression (unfacilitated type of TW)Attentional control (standard care)
Wallander 2011109WSD (unfacilitated type of TW)SMC
Warner 2006108Written emotional disclosure (unfacilitated type of TW)Time management
Wetherell 2005117Emotional disclosure (writing or talking) (unfacilitated type of TW)Time-management writing
Willmott 2011104Written emotional expression – positive and negative (unfacilitated type of TW)Details of previous day’s prior to heart attack
Zakowski 200484Written emotional disclosure (unfacilitated type of TW)Details of daily activity writing

WSD, written self-disclosure.

Interventions definitions

TABLE 102

Intervention definitions as provided by included studies

First author, yearExperimental conditionControl condition
Definition group 1Definition group 2Definition group 3Definition group 1Definition group 2
Abel 200450To write about innermost thoughts related to diagnosis of HIV and living with the diseaseTo write about their daily activitiesInexpressive writing
Arden-Close 201380To write about the patient’s diagnosis and treatment as follows:
Day 1: describe the diagnosis and treatment chronologically and what led to what, without mentioning emotions
Day 2: part 1, describe how you felt and what you thought at the time of the diagnosis. Part 2, what impact has your diagnosis and treatment had on your life, and has it caused you to change priorities?
Day 3: how do you currently feel and think about the diagnosis and treatment? Are your current thoughts and feelings the same as at diagnosis? Would you be able to cope with similar situations better because you have experienced it?
To write about what the patient did the previous day (time management)
Averill 2013100To write on traumatic and upsetting life experiences:
Session 1: the most traumatic and upsetting experience of the patient’s life
Session 2: continue writing about the topic described in session 1, or choose an alternate topic
Session 3: continue writing about the topic described in session 1, or choose an alternate topic
Session 4: as above, but a suggestion is made to relate experiences to subsequent life events
Study measures were also completed
To complete the study measures
Bartasiuniene 2011102Disease (self-focused): to write about their deepest thoughts and feelings related to their illnessTo write about daily routine until illnessParticipants in this group did not write anything but received usual care: received standard psychological care, pointed mostly for relaxation (e.g. aromatherapy, music therapy)
Bernard 200593To write about the most stressful and upsetting aspects of their illness and treatment (or whatever they had reported on the IES-R, e.g. psychosis, paranoia) using a protocol adapted from Pennebaker and Beall1To write about different non-emotional topics (activities that day, the room they were in and plans for next week) on each day in a factual manner
Broderick 2005118To write about any traumatic event, current or past, in their lifeTo write focusing more on the meaning of their past traumaTo write about day-to-day activities in relation to the time invested. Only facts should be written, excluding any emotions associated with themComprised viewing an educational videotape about RA [Education (ED)]
Broderick 2005118The exercise was focused on factual retelling of an important current or past traumatic event, along with emotional expression and cognitive reappraisal. The writing should involve deep thoughts and feelings about the eventTo write without concern about spelling or grammar about day-to-day activities in relation to the time invested
Session 1 asked for a description of plans for the past week
Session 2 focused on the previous 24 hours
Session 3 focused on the upcoming week
It was emphasised that only facts should be written, not any emotions associated with them
Canna 200694To write about their deepest thoughts and feelings related to their illnessParticipants in this group were assigned to a non-emotional task, for which they had to describe in detail what they had done since they wake up
Cepeda 200888To write, while at home, for at least 20 minutes, once a week, for 3 weeks, a story about how cancer affected their livesAs an attention control group, patients were asked to complete, while at home, the McGill Pain QPatients were asked simply to attend weekly medical follow-up visits (i.e. the same clinic schedule as the other two groups) to receive usual customary care
Craft 201374To write about the deepest thoughts and feelings about breast cancerTo write about the deepest thoughts and feelings about a self-selected worst traumaTo write about facts of treatment only: day 1, diet; day 2, exercise; day 3, sleep pattern; day 4, medicationsNon-writing
Dennick 201484To write about their thoughts and feelings about any stressful experience over the last month or current concern (i.e. not specifically diabetes related)Description of the previous day’s activities, without prompt to discuss thoughts or feelings
D’Souza 2008101To write about a trauma or upheaval or stressful experience that you may be experiencing right now, or that you experienced at some other time in your life, particularly the most stressful that you have experienced and is the most significant to you, and ideally one that you have not talked about in detail with others. Participants were encouraged to write about the facts as well as their deepest feelings, and to try to write about the same events for all 4 writing daysTo write about their activities for the past week (session 1) and past 24 hours (session 2), and their planned activities for the next 24 hours (session 3) and next week (session 4)
Instructions asked participants to write only about their actions, but to refrain from writing about their feelings or opinions
Gellaitry 201075This intervention comprises several types of expressive writing performed in a 4-day treatment
Day 1: emotional disclosure – exploring deepest thoughts and feelings about your experience of breast cancer
Day 2: cognitive appraisal – making sense of your illness. What does having breast cancer mean to you?
Day 3: benefit finding – perceived benefits of your experience; challenges you have overcome; changed outlook on life/priorities?
Day 4: looking to the future – coping strategies; sharing experience with others
Gidron 199698To write about their most traumatic experiences and then in a brief predetermined format to elaborate orally on the most severe event about which they wroteTo write about their casual daily agenda without affective content and then describe daily activity orally
Gillis 2006119Participants were asked to identify a stressful experience that continues to bother them, and they were given additional guidance on how to identify such an experience (e.g. it is difficult to think or talk about, makes them feel anxious or upset when encountering reminders of the experience or prompts intrusive thoughts). They were instructed to make the memories, images and emotions as vivid as possible, and to write both the facts and their deepest feelings about the experience. In addition, they were instructed to explore how the stressful experience has affected your FM or how you deal with having FM or you might want to explore how the experience has affected your relationships with others. Participants were encouraged to work on and resolve one stressful experience at a time, and this means that you might write about the same experience over several days or all 4 days. However, if they find that they had worked it out or feel better about one experience, they should go on and write about another stressful experienceTo write about different time periods for each of the 4 writing days and to write about only their actual behaviours or planned actions rather than their feelings or opinions
These four time periods were:
Day 1: what they did with their time over the last week
Day 2: what they did with their time over the last 24 hours
DAY 3: what they plan to do with their time over the next 24 hours
Day 4: what they plan to do with their time over the next week
Golkaramnay 200768The group members met in virtual chat rooms through which they communicated through written messages. The text-based communication was synchronous and in real timeNo intervention
Graf 200895To write about the most stressful and upsetting experiences of your entire lifeTo write about their plans for the rest of today for 20 minutes. You may or may not want to discuss your writing or the themes of your writing with your therapist. This is your choice. Your writing will be kept completely confidential. Do not worry about spelling, sentence structure, or grammar
Graham 200851Before writing each letter, intervention group participants completed a short exercise designed to focus their attention on existing anger related to their pain experience. In this brief questionnaire, participants were asked to consider if they currently or recently felt anger towards a health-care provider, themselves, or someone or something else and, if so, to remember and/or focus on it. Participants were given a writing tablet and instructions to write a letter to the person at whom or thing at which they were most angry. They were instructed to focus on their anger rather than other emotionsParticipants in the control group did not complete the short anger-focusing exercise and were instructed to write a letter to a person of their choosing, describing their plans for the upcoming day. They were instructed to write about their goals in detail but without discussing any of their thoughts and feelings. Control group participants believed they were providing information about what they were able to do in a given day
Grasing 201090The writing task focused on traumatic and upsetting life experiences
Session 1: the most traumatic and upsetting experience of the patient’s life
Session 2: continue writing about the topic described in session 1, or choose an alternative topic
Session 3: continue writing about the topic described in session 1, or choose an alternative topic
Session 4: as above, but a suggestion is made to relate experiences to subsequent life events
The time-management task emphasised objective, factual events. Time-management control group wrote about how time was spent during the previous day; current day (prior to the session); during the remainder of the current day (after the session); during the upcoming week
Halpert 201052To write about the thoughts and feelings about IBS. They had to really let go, and explore the very deep emotions and thoughtsParticipants who intended to write but did not start writing were offered the option to remain in the study and complete the follow-up questionnaires without writing formed the non-writing group
Harris 2005106Trauma writing described as writing about stressful of traumatic experiencesTo write about positive experiences such as events that stimulated feelings of happiness or joyTo write on neutral topics focused on the events of the previous day (control group)
Hamilton-West 2007114To write about any stressful experiences encountered over the last month, or any worries or concerns that are currently troubling you
These might be related to the AS or not
To write in detail about the plans for the following day. Participants were permitted to write about one topic only, or move from one topic to another
Henry 201053To write about positive thoughts and feelings regarding their experience with breast cancerParticipants did not write, just received treatment as usual
Hevey 2012103They were asked to write about their thoughts and feelings in relation to having had a heart attackTo described daily activities in the year prior to their heart attack
Hong 201167Music therapy programme, using songwriting-related activities consisted of three stages:
Stage 1: preparing songwriting for finding preferred songs
Stage 2: doing songwriting
Stage 3: reinforcing songwriting
Free time was given to the participants allocated to the control group for the 16 weeks the intervention took place. Subjects just underwent the usual daily life at the nursing home
Hughes 200754To write about their very deepest thoughts and feelings about [their] cancer and cancer treatmentParticipants were given general health information typically offered to patients by their health-care providers, and was considered a treatment as usual control
Ironson 201371To write about their worst trauma/current conflicts and then to write about what they did and future plansTo write about daily events
Jensen-Johansen 201376To write about a traumatic or distressing event and to explore their deepest feelings and emotions associated with this experience. They were free to write about their breast cancer as well as non-cancer experiences, and to switch topics during the interventionTo write as objectively and as detailed as possible in an emotionally neutral manner about their daily activities
Krpan 201396To write about their deepest thoughts and feelings about an extremely important emotional issue that had affected them and their lifeHow they organised their day
Kraaij 201055To describe their deepest thoughts and feelings regarding their HIV-positive status or any other emotionally significant topic. Participants were instructed to pay special attention to issues that they had not previously disclosed to others. All writing assignments were completed through a website that was especially designed for the present studyThe self-help programme consisted of a workbook, a work programme and a CD-ROM. In the first week, participants were asked to do mindfulness-based relaxation exercises, and to continue these exercises in the following 3 weeks. In the second and third week, participants learned to identify and change irrational cognitions and to practise counterconditioning. In the fourth week, they were guided to formulate a realistic, concrete goal and to improve their self-efficacy to reach this goalParticipants on the waiting list did not receive any intervention. They were offered the interventions after completion of the study
Lange 200369To stimulate self-confrontation, participants had to write in the first person and in the present tense, describing in as much detail as possible the sensory perceptions that they experienced at the time of the traumatic event, including olfactory, visual and auditory sensationsFor ethical reasons, the participants in the control condition were not kept waiting until the treatment group had completed the follow-up. They received treatment directly after the treatment group had terminated treatment
Lumley 2011115To write (or speak) in a journal about this stressful experience, incorporating both facts and deepest feelingsTo write (or speak) about positive emotional events in their lives, including both facts and feelings, and to describe their memories as vividly as possibleTo write (or speak) about their daily activities over four different time intervals: day 1, the previous week; day 2, the previous day; day 3, their plans for the next day; day 4, their plans for the next week
Time-management type of control
Lumley 2014116To identify a stressful or traumatic experience that continued to cause them stress and to write about their most vivid memories and innermost thoughts and feelings about that experience. Also about finding meaning from it and anything they had learned, and how they coped with it nowCoping skills trainingHow they spent and managed their time over the previous week, including eating, physical activity and sleepArthritis education
Mann 200172To write about a somewhat positive future To write in journals nor were told to imagine an optimistic future in which they would only have to take one pill per day for HIVParticipants did not write nor were told to imagine an optimistic future in which they would only have to take one pill per day for HIV. However, efforts were made to equalise the amount of time that researchers spent with participants in the two conditions
McElligott 200687To write about their deepest thoughts and feelings related to their illnessTo write about details of previous day
Meshberg-Cohen 201091To write about personal traumatic/stressful experiencesTo write on neutral topics (e.g. what they ate on the previous day, what they did since waking up yesterday)
Milbury 201481To write about their deepest emotions and thoughts regarding their cancer experience with slightly different probes at each session (e.g. how the diagnosis and treatment interfere with their lives; treatment-related decision-making; and fears about the future)To write about four neutral topics: dietary behaviours, physical activity and exercise behaviours, attitudes towards smoking and other substance use, and sleep habits
Mosher 201277Writing about their deepest thoughts and feelings regarding their cancerTo describe yesterday’s activities in a factual manner
Paradisi 2010110To describe the worst experience in their lives related to their disease. After each writing session patients were directed to phototherapyTo write about their best possible future self and life goals. After each writing session patients were directed to phototherapyNon-emotional control group. No definition given
Park 201278Express with writing about cancer-related emotion in 20 minutesNo intervention
Pauley 201182To write about any aspect of their cancer that they would characterise as positiveTo indicate what was negative about their experienceTo write about the events of the day, the layout of their homes, or the responsibilities at their current position
Petrie 200456To write about the most traumatic and emotional experiences of their lives, about deepest thoughts and feelings about an event that they had not previously discussed with others. They could write about HIV-related topics or any other issues of emotional importance to themTo write about how they used their time, but with slightly different orientations each day: what they had done in the previous 24 hours, and what their plans were for the next 24 hours, the next week, and the next 12 months. They were encouraged to write in a purely descriptive and objective way with minimum expression of emotions
Richards 200097To write about the deepest thoughts and feelings, regarding an experience that had not been previously shared with others at all or in very little detailTo write about an assigned topic usually on how they manage their timeParticipants were asked to go about their daily routine
Rickett 201166Workshop series in two groups, split in first and second (control group) workshop times. Participants in group 1 undertook the first poetry writing programme, while the remaining participants in group 2 undertook the second
During each meeting, participants read poetry selections, discussed aspects of poetry writing, wrote poems and read them aloud to the group
The second group was wait-listed to enable comparison with the first group in the workshop
Rini 201486To explore their deepest emotions and emotions about the time before, during and after transplant and then any aspect of their transplantPeer helpingExpressive helpingThey wrote a factual account of their experience before, during and after their transplant
Robinson 200899Participants were assigned an e-mail therapist. eBT was administered by a team of therapists of different backgrounds. The therapy included online supervision and feedback from the participants. All treatment included eliciting history; asking participants to keep a dietary and feelings diary; identifying and modifying negative automatic thoughts and other cognitive styles common in eating disorders; encouraging regular meals with adequate carbohydrate; examining relationships and aspects of the participants behaviour which might exacerbate the eating disorder; managing the endingParticipants were sent an e-mail and had to spend some time at least twice a week, writing about their difficulties and to send it to one of the authorsParticipants were placed on a waiting list. After 3 months they were reassessed and offered either eBT or SDW by random allocation
Rosenberg 200283To write about their experience with cancer and its treatment. They were allowed to write about other experiences in their lifeAny type of writing was performed
Sharifabad 2010105To write about their most traumatic or upsetting life experiencesTo write about an assigned neutral topic, describing the specific event or object in detail without describing thoughts or feelings relating to the topic
Sloan 201270To write about the same MVA event during each writing session, about their deepest emotions and thoughts at the time of the MVA was emphasised, as well as the importance of providing detailed information about the MVA. During the second session, they had to add information about what they were thinking or feeling as the event was happeningParticipants in the waiting list were encouraged to contact the project coordinator any time if they were having problems
Smyth 1999107To write about the most stressful experience that they had ever undergoneTo describe their plans for the day (framed as a time-management exercise to reduce stress)
Smyth 2008121To write about their traumatic experienceTo write about a neutral topic: time-management control writing related to their daily plans
Stark 201057To write about their most traumatic experience (based on Broderick et al.118). Concepts of the Change Theory were incorporated by asking also patients to write their experiences as a story with a clear beginning, middle and end, as well as incorporate their deepest thoughts and emotions regarding this event, to try to perceive themselves as survivors and attempts to find any positive results that may have occurred as a result of this traumatic experience
Tabolli 2012111To write longhand, continuously, about the most stressful event in their life, about the experiences with psoriasis
After the intervention, participants received information and educational material on the disease and its management
Control patients received only an educational intervention: patients received information and educational materials
Taylor 200389To write about their deepest thoughts and feelings about the most distressing experience of their entire life for a period of 20 minutes
Participants were encouraged to connect their topic to relationships with others (e.g. parents, caregivers, lovers, friends, relatives) and to their past, present, or future
Theadom 201058To write about your very deepest thoughts and feelings about an extremely important emotional issue that has affected you and your life-Day 1: to write about exactly what you did yesterday from the time you got up until the time you went to bed
Day 2: to write about what they had eaten the day before
Day 3: to write about the physical activity they had undertaken the previous day
Van Dam 201392Ten individual sessions of writing:
1. In detail about the most traumatic event(s) they had experienced. The writing had to be in the first person and in the present tense, addressing sensory experiences, painful facts thoughts and emotions experienced during the trauma
2. To write a letter of advice to a friend or loved one, imagining that they had experienced the same event. Patients were asked to give advice on how to handle the thoughts and emotions
3. Write a similar letter to themselves
4. Writing a reflective letter about the trauma and its impact on their life, and their resolutions for dealing with the trauma in future
Treatment as usual
Vedhara 2007112To write or talk about traumatic and stressful eventsTo provide a factual descriptive (i.e. non-emotional) account of their activities in a specified time period (e.g. yesterday)-
Wagner 201073To write about some extremely upsetting or traumatic event that they had experienced in their lifeTo describe in detail, as objectively as possible (a) their plans for the remainder of the day; (b) the clothes they are wearing; (c) any particular object or event of their choosing; or (d) the contents of their closet
Walker 199979To write about the deepest thoughts and feelings about their cancer experience (during 1 day only)To write about the deepest thoughts and feelings about their cancer experience (during 3 separate days)The attentional control received usual care and on their final day of treatment the researcher met with them to chat about plans for trips or current events not related to cancer
Wallander 2011109WSD was administered in three 20-minute sessions: one in the clinic and two by telephone in the home (no additional information was reported)Participants received SMC appropriate to their health status from a paediatric GI specialist. SMC for RAP generally consists of follow-up office visits and/or telephone consultations, education support, dietary instructions, as well as possible oral medication and supplements to increase dietary bulk, decreased acid or increase motility, as deemed medically appropriate by treating GI specialist
Warner 2006108To write about past negative events, about a trauma or problem that they may be experiencing at the moment of the intervention, or that they had experienced at some other time in their lifeTo write privately about how you manage their time, writing about a different topic every day
Wetherell 2005117To write about their deepest emotions and thoughts about the most upsetting experience in their life, to really let go explore their feelings and thoughts about it. If they were not able to write about it they were prompted to write about anything that had upset them significantly in the past (it had to be a new topic, never discussed)To write or talk about one of three topics. To describe, in detail:
(1) everything they had done during that day
(2) were planning to do the following day
or
(3) during the forthcoming weekend
Control patients were instructed that the description should be detailed and factual and to avoid emotion during their accounts
Willmott 2011104To write about their thoughts and feelings in relation to having had a heart attack including any emotions (positive and negative) and thoughts about how they might cope
Note that on day 3, additionally, they were encouraged to try to wrap things up by, for example, thinking about how the heart attack may affect their future and again the importance of exploring thoughts and feelings was emphasised
To describe what they usually did on a Saturday, Sunday and Monday before they experienced a heart attack (each day forming the focus of one session’s writing)
They were asked to describe their activities in detail and encouraged to be as objective as possible when doing so
They were told that the important thing was not to get distracted by emotions but to focus on simple descriptions of what they did, such as where they went and the things they ate
Zakowski 200484To write continuously for 20 minutes about their deepest thoughts and feelings regarding their cancer experienceTo describe in detail their daily activities in a non-emotional manner in accord with previously published procedures

–, not included; CD-ROM, compact disc read-only memory; IES-R, Impact of Event Scale-Revised; McGill Pain Q, McGill Pain Questionnaire.

Interventions as evaluated by the reviewers

TABLE 103

Facilitated and non-facilitated intervention names in included studies

First author, yearExperimental conditionControl condition
Intervention group 1Intervention group 2Control group 1Control group 2Facilitated intervention? Yes/No
Abel 200450Unfacilitated EWFactual writingNo
Arden-Close 201380Unfacilitated EWTime-management writingNo
Averill 2013100Unfacilitated EWNon-writingNo
Bartasiuniene 2011102Unfacilitated EWFactual writingNon-writingNo
Bernard 200693Unfacilitated EWFactual and time-management writingNo
Broderick 2004113Unfacilitated EWUnfacilitated EWTime-management writingAttention controlaNo
Broderick 2005118Unfacilitated EWTime-management writingSMCNo
Canna 200694Unfacilitated EWFactual writing?
Cepeda 200885Unfacilitated EWAttention controlaSMCNo
Craft 201374Unfacilitated EWUnfacilitated EWFactual writingNon-writingNo
Dennick 201488Unfacilitated EWFactual writingNo
D’Souza 2008101Unfacilitated EWTime-management writingNo
Gellaitry 201075Unfacilitated EWSMCNo
Gidron 199698Unfacilitated EWFactual writingNo
Gillis 2006119Unfacilitated EWTime-management writingNo
Golkaramnay 200768Internet chat roomNo interventionYes
Graf 200895Unfacilitated EWTime-management writingNo
Graham 200851Questionnaire plus unfacilitated EWFactual goal writingNo
Grasing 201090Unfacilitated EWTime-management writingNo
Halpert 201052Unfacilitated EWNon-writingNo
Hamilton-West 2007114Unfacilitated EWTime-management writingNo
Harris 2005106Unfacilitated EWPositive writingFactual writingNo
Henry 201053Positive writingSMCNo
Hevey 2012103Unfacilitated EWFactual writingNo
Hong 201167SongwritingWaiting listYes
Hughes 200754Unfacilitated EWSMCNo
Ironson 201371Unfacilitated EWFactual writingNo
Jensen-Johansen 201376Unfacilitated EWTime-management writingNo
Kraaij 201055Website structured writingWaiting listNo
Krpan 201396Unfacilitated EWTime management writingNo
Lange 200369Website InterapyWaiting listYes
Lumley 2011115Unfacilitated EWPositive writingTime-management writingNo
Lumley 2014116Unfacilitated EWTime-management writingNo
Mann 200172Positive writingNon-writingNo
McElligott 200687Unfacilitated EWFactual writingNo
Meshberg-Cohen 201091Unfacilitated EWFactual writingNo
Milbury 201481Unfacilitated EWFactual writingNo
Mosher 201277Unfacilitated EWFactual writingNo
Paradisi 2010110Unfacilitated EWPositive writingNon-EWNo
Park 201278Unfacilitated EWNo interventionNo
Pauley 201182Unfacilitated EWPositive writingFactual writingNo
Petrie 200456Unfacilitated EWTime-management writingNo
Richards 200097Unfacilitated EWTime-management writingSMCNo
Rickett 201166Poetry writingWaiting listYes
Rini 201486Unfacilitated EWFactual writingNo
Robinson 200899Unfacilitated EWWaiting listNo
Rosenberg 200283Unfacilitated EWNon-writingNo
Sharifabad 2010105Unfacilitated EWFactual writingNo
Sloan 201270Written exposure therapyWaiting listYes
Smyth 1999107Unfacilitated EWTime-management writingNo
Smyth 2008121Unfacilitated EWTime-management writingNo
Stark 201057Unfacilitated EW (mixed writing)Non-writing?
Tabolli 2012111Unfacilitated EWNon-writingNo
Taylor 200389Unfacilitated EWSMCNo
Theadom 201058Unfacilitated EWFactual writingNo
Van Dam 201392Unfacilitated EWTreatment as usualNo
Vedhara 2007112Unfacilitated EWFactual writingNo
Wagner 201073Unfacilitated EWFactual and time-management writingNo
Walker 199979Unfacilitated EWPositive writingSMCNo
Wallander 2011109Unfacilitated EWSMCNo
Warner 2006108Unfacilitated EWTime-management writingNo
Wetherell 2005117Unfacilitated EWTime-management writingNo
Willmott 2011104Unfacilitated EWFactual writingNo
Zakowski 200484Unfacilitated EWFactual writingNo

Unfacilitated EW, unfacilitated type of TW or an adaptation of it.

a

This attention control group has not been considered for analysis in current systematic review given it was considered to have an active component and therefore not suitable for comparison. It would have been taken into account in the situation where the two other intervention groups had undertaken the same educational activity on top of the writing exercise.

Additional information on the interventions assessed

TABLE 104

Therapeutic writing interventions: descriptions in included studies

First author, yearFundingFinancial compensationaMethod of instructionTopic of the interventionNumber of topicsTopic change allowedDuration (minutes)LengthIn a groupType of writingCollection of writingsCarer feedback
Abel 200450YesYesVerballyDisease self-focused1No20Three consecutiveNRHandwritingNRNR
Arden-Close 201380NoNoTelephoneDisease and treatment self-focused1 (with variations each day)Yes20Three non-consecutive (over 3-week period)NoHandwritingYesNR
Averill 2013100YesNoTelephoneDisease self-focused1No20Three non-consecutive (over 1 week)NoHandwritingNRNo
Bartasiuniene 2011102NoNoIn writingDisease self-focused1NR30Four consecutiveNoHandwritingNRNR
Bernard 200693NoNoTelephoneDisease and treatment self-focused1No15Three non-consecutive (over 10 days)NoHandwritingNoYes
Broderick 2004113YesNoVideotape1. Self-selected trauma
2. Enhanced meaning self-selected trauma
2No20Three consecutiveNoHandwritingNoNo
Broderick 2005118YesYesVerballySelf-selected trauma1No20Three non-consecutive (at 1-week intervals)NoHandwritingYesYes
Canna 200694YesNo
Cepeda 200885YesNoVerballyDisease self-focused1No20Three non-consecutive (at 1-week intervals)NoHandwritingYesNR
Craft 201374NoNoIn writing1. Disease self-focused
2. Self-selected worst trauma
2No20Four consecutiveNoBy hand or word processorYesNR
Dennick 201488PartNoIn writingSelf-selected trauma1Yes203 days over 1 weekNoHandwritingNRYes
D’Souza 2008101YesYesIn writingSelf-selected trauma1No20Four non-consecutive (at 2-week intervals)NoHandwritingYesNR
Gellaitry 201075YesDisease self-focused2Yes20Four consecutiveNoHandwritingYesYes
Gidron 199698NoNoVerballySelf-selected trauma1No20Three consecutiveNoHandwriting and oralNRNR
Gillis 2006119NoNoIn writingSelf-selected social trauma disease self-focused3Yes15–20Four consecutiveNoHandwritingYesNR
Golkaramnay 200768YesNoIn writingHere-and-now tasks1NR90Weekly for 12–15 weeksYesWord processorYesYes
Graf 200895NoNoIn writingSelf-selected worst trauma1No20Two sessions (2 weeks apart)NoHandwritingYesYes
Graham 200851YesYesIn writingSelf-selected anger1No20Two sessions (2.5 weeks apart)NoWord processorYesNR
Grasing 201090NoYesIn writingSelf-selected trauma1Yes20Four sessions over 17 daysNoHandwritingYesNR
Halpert 201052NoNoIn writingDisease self-focused1Yes30Four consecutiveNoHandwritingNRNR
Hamilton-West 2007114NoNRIn writingDisease self-focused1Yes20Three consecutiveNoHandwritingNRNR
Harris 2005106YesYes1. Self-selected trauma 2. Self-selected positive experience1No20Three non-consecutive (at 1-week intervals)NoHandwritingYesNR
Henry 201053YesYesIn writingDisease, positive self-focused1No20One sessionNoHandwritingYesNR
Hevey 2012103NoNRIn writingDisease self-focused1No20Three consecutiveNoHandwritingYesNR
Hong 201167NoNoVerballySelf-selected past experience or everyday live> 1Yes60Sixteen sessions at weekly intervalsYesHandwritingNR
Hughes 200754NoNoIn writingDisease self-focused1NR30Three consecutive (over a five-time period)HandwritingNRYes
Ironson 201371YesNoIn writingSelf-selected worst trauma (or current conflicts)1Yes20Four consecutiveNoHandwritingYesNR
Kraaij 201055NoNoNRDisease self-focused1Yes30Four non-consecutive (at 1-week intervals)NoWord processorYesNR
Krpan 201396YesYesNRSelf-selected past trauma1NR203 consecutive daysNRHandwritingNRNR
Jensen-Johansen 201371YesNoTelephoneSelf-selected trauma1Yes20Three non-consecutive (over a 3-week period)NoHandwritingYesNR
Lange 200369YesNoIn writingSelf-selected trauma: description of sensory perceptions including olfactory, visual and auditory sensations1NR4510 non-consecutive (over 5 weeks at 2-week intervals)NoWord processorYesYes
Lumley 2011115YesYesVerbally and in writing1. Self-selected stressful event 2. Self-selected positive event1No20Four consecutiveNoHandwritingYesNR
Lumley 2014116YesYesVerbally and in writingSelf-selected trauma4No20Four within 1 weekNoHandwritingYesNR
Mann 200172YesYesIn writingSelf-selected positive future1NR10Four non-consecutive (twice a week)NRHandwritingNRNR
McElligott 200687NoYesVerbally and in writingDisease self-focused1NoNRThree (at 1-week intervals)NoHandwritingNoNR
Meshberg-Cohen 201091YesNoIn writingSelf-selected trauma1NR20Four consecutiveNoHandwritingYesNR
Milbury 201481YesYesIn writingDisease and treatment self-focused1NR20Four non-consecutive (over 10 days)NoHandwritingYesNR
Mosher 201277NoYesIn writingDisease (self-focused): deepest thoughts and feelings regarding their cancer1NR20Four non-consecutive (over 8 weeks)NoHandwritingYesYes
Paradisi 2010110YesNRIn writing1. Disease self-focused worst experience
2. Best possible future self and life goals
1No203 consecutive daysNoHandwritingNoNR
Park 201278NoNRIn writingDisease self-focused1NR20Four non-consecutive (at 1-week intervals)YesHandwritingNRNR
Pauley 201182YesYesIn writing1. Disease, positive self-focused
2. Disease, negative self-focused
1NR203 days (at 1-week intervals)NoHandwriting and word processorYesNR
Petrie 200456YesNRIn writingSelf-selected worst trauma or self-focused disease1Yes304 consecutive daysNoWord processorYesNo
Richards 200097YesYesIn writingDisease self-focused1NR203 consecutive daysNoHandwritingYesNR
Rickett 201166YesNRIn writing and verballyDiscussed aspects of poetry writing, wrote poems1NR120Weekly for 8 weeksYesHandwritingYesYes
Rini 201486YesYesIn writingDisease and treatment focused4No20Weekly, over 4 weeksNohandwritingYesNR.
Robinson 200899NoNoIn writingSelf-selected difficulties (not further specified)1NRNRTwo sessions (over 1 week)NoHandwritingYesYes
Rosenberg 200283YesNoIn writingDisease and treatment self-focused1Yes20–304 consecutive daysNoHandwritingNRNR
Sharifabad 2010105YesNoIn writing and verballySelf-selected worst experience1NR20Three sessions (at 1-week intervals)YesHandwritingNRNR
Sloan 201270YesYesIn writing and verballyDisease self-focused2Yes120Four sessionsNoHandwritingNRYes
Smyth 1999107YesYesIn writingSelf-selected worst experience1NR203 consecutive daysNoHandwritingYesNo
Smyth 2008121NoYesIn writingSelf-selected experience1NR20Three consecutive sessions (with 15-minute rest interval between each session)NoHandwritingNRNR
Stark 201057NoYesIn writingSelf-selected worst experience from a positive perspective1No203 consecutive daysNoHandwritingNRNR
Tabolli 2012111YesNoIn writingDisease self-focused1NR203 consecutive daysNoHandwritingNRYes
Taylor 200389YesNoIn writingSelf-selected worst experience1NR203 consecutive daysNoHandwritingYesNR
Theadom 201058YesNoIn writingSelf-selected emotional issue1No203 consecutive daysNoHandwritingYesYes
Van Dam 201392YesNoVerballySelf-selected trauma4No45–6010 sessions, 1 per weekNoHandwritingYesYes
Vedhara 2007112YesNoIn writingSelf-selected traumatic and stressful events1Yes204 consecutive daysNoHandwritingYesNR
Wagner 201073NoYesIn writingSelf-selected trauma, past negative events, problem1Yes20Four non-consecutive (at 1-week intervals)NoWord processorYesNR
Walker 199979NoIn writingDisease self-focused1NR302–3 consecutive daysNoHandwritingYesNR
Wallander 2011109YesNoIn writing and verballyNRNRNR20Three sessions (in 6 days)NoHandwritingYesNR
Warner 2006108YesYesIn writingSelf-selected trauma> 1NR15–203 consecutive daysNoHandwritingYesYes
Wetherell 2005117YesNoVerballySelf-selected most upsetting experience1NR20 (with so many breaks as wished)1 dayNoHandwriting or tape recordingYesYes
Willmott 2011104YesNoIn writingDisease self-focused2NR10–20 (time spent writing in each session had to be recorded)3 consecutive daysNoHandwritingYesNR
Zakowski 200484YesNoIn writing and verballyDisease self-focused1No203 consecutive daysNoHandwritingYesNR

NR, not reported.

a

Financial compensation could be done for participation in the study or as part of the outcomes collection.

Outcomes assessed

TABLE 105

List of instruments and/or outcome measures used in included studies

First author, yearPhysiological measuresBiomarkers measures of disease progressionPatient-reported outcome measuresResource-use measuresAdherenceComments
Abel 200450Cognitive reorganisation
Social stigma (stigma scale)
Depression (CES-D)
QoL (SF-36)
Arden-Close 201380Perceived stress (PSS)
Intrusive thoughts (IES)
QoL (FACT-General)
Averill 2013100Affect (ABS)
Emotional approach coping (specific scale)
Depression (GDS)
Ambivalence over emotional expression (AEE)
Social support (Social Constraints scale)
QoL (McGill QOL)
Bartasiuniene 2011102Emotional states [PANAS-X(b)]
Bernard 200693Trauma of psychosis (IES-R)
Recovery style (RSQ)
Insight (IS)
Anxiety – depression (HADS)
Mood [PANAS- X(a)]
Broderick 2004118Disease activity (Disease Activity Rating scale)QoL (SF-36v2 Health Survey)
Broderick 2005118Anxiety and depression (STAI-S, BDI-II)
Physical health (FIQ, CLINHAQ)
QoL (MOS-SF-36, QOL)
Pain (McGill Pain Q-SF, MPI)
Canna 200694Anxiety (BAI, STAI)
Depression (BDI-II)
Distress symptoms (BSI, GSI)
Panic symptoms (PSWQ)
Physical symptoms (PILL)
Mood (PANAS)
Life satisfaction (QoLI)
Social support (MSPSS)
Number of treatment sessions
Cepeda 200885Average pain intensity, well-being
Craft 201374QoL (FACT-B)
Dennick 201488CES-D
PAID
EQ-5D VAS and utility
SDSCA
D’Souza 2008101Headache frequency, disability and severityPhysical symptoms (SCL-90-R)
Immediate mood [PANAS-X(d)]
Behavioural disability from headache (MIDAS)
Gellaitry 201075Social support (SOS)
QoL (FACT-B)
Mood (POMS)
AEs
Number of all medical visits (scheduled and unscheduled hospital appointments, GP appointments and visits to the nurse), regardless of whether they were cancer related or not
Gidron 199698Physical symptoms (PILL, Mississippi scale for PTSD)
Mood, depression, negative and positive affect [PANAS-X(a), IES, BDI-II]
Health-care visits [mean (SD) number of health-care visits in the last month]
Gillis 2006119Immediate negative mood (PANAS-X)
Negative affect (NA subscale of PANAS-X)
Pain (pain subscale of AIMS2)
Fatigue (FSS)
Social support (subscale of AIMS2)
Global health status (FIQ)
Physical dysfunction (AIMS2)
Sleep quality (4-item scale)
Total number of visits to specialist – related or not to FM – during the last month
Golkaramnay 200768Patient distress (OQ-45.2)
Symptomatic distress [SCL-90-R (GSI)]
Subjective physical well-being (GBB)
Life satisfaction (FLZ)
Graf 200895Mood (DASS)
Functioning (OQ-45.2)
Graham 200851Anger expression and meaning making (expressed anger)
Sadness/anxiety, depressed mood (CES-D)
Pain severity (WHYMPI)
Feelings of personal control over pain (SOPA)
Resource use (number of years attending the centre)
Grasing 201090BP and heart rate (measured with patients in a sitting position)Craving intensity (BSCS)
Mood (POMS, BSI)
Stress (PSS)
Total number of contacts completed outpatient mental health clinic visits for treatment of substance abuse disorders
Halpert 201052Cognition (CG-FBD)
Catastrophising/coping (CT3)
IBS-specific QoL (IBS-QoL)
IBS severity (IBSSS)
Hamilton-West 2007114Physical status – fatigue and pain mainly (BASDAI, BASFI, BAS-G)
Depression (HADS)
Harris 2005106Lung function through spirometry (FEV1, FVC)Adherence to probes
Henry 201053Depressive symptomatology (CES-D)
Mood states (POMS)
Physical health (Survey – 18 physical symptoms items)
Hevey 2012103Anxiety and depression (HADS)
Coping (Brief COPE)
Negative affectivity (DS-14)
QoL (Mac New HRQOL)
Hong 201167Cognitive functioning (MMSE-K)
Hughes 200754Mood (PANAS)
Sickness related dysfunction (SIP)
Avoidant and intrusive thoughts (IES)
Patient’s history of prior disclosure (DIS)
Ironson 201371CD4+ count (flow cytometry) and VL (quantitative reverse-transcriptase PCR)HIV-related physical symptoms of HIV (checklist)
Psychosocial distress (Davidson PTSD scale), depression (HAM-D)
Yes
Jensen-Johansen 201376Distress (IES)
Depression (BDI-SF)
Negative mood (POMS)
Vigour (POMS-v)
Positive mood (PPMS)
Kraaij 201055Depressive symptoms (HADS)
Krpan 201396PHQ
BDI
Lange 200369Intrusions and avoidance (IES)
Physical symptoms (SCL-90-R)
Lumley 2011115RA severity (swollen joint count, walking speed and grip strength). Physician’s global rating of disease activity (100-mm VAS)ESRSelf-reported physical and psychological functioning (AIMS2)
Affective and sensory pain (McGill Pain Q-SF)
Pain behaviour (structured observation system)
Immediate mood (PANAS-X)
Lumley 2014116RA severity (swollen joint count, walking speed and grip strength). Physician’s global rating of disease activity (100-mm VAS)Inflammation (CRP)Self-reported physical and psychological functioning (AIMS2)
Affective and sensory pain (McGill Pain Q-SF)
Mann 200172Optimism (LOT)Yes
McElligott 200687Self-esteem (ADSEI)
Depression (CDI)
Behavioural problems (ADSEI)
Anxiety (RCMAS)
Physical symptoms (PSC, PSC-Y)
Physical well-being
Number of visits to the clinic and number of days in hospital
Meshberg-Cohen 201091Physical health problems (PILL)
Distress (BSI, GSI)
Depression (CES-D)
Affect (PANAS-X)
Drug craving (BSCS)
PTSD severity (PDS)
Milbury 201481Fatigue (BFI)
Intrusions and avoidance (IES)
Psychological well-being (CES-D)
Cancer-related symptoms (MDASI)
Sleep disturbance (PSQI)
QoL (SF-36)
Mosher 201277Existential well-being (FACIT-Sp)
Psychological well-being (DT, HADS-A)
Sleep disturbance and fatigue (PSQI, FACIT-F)
The total Global Sleep Quality score was used in this study
Paradisi 2010110Psoriasis severity (PASI)QoL (Skindex-29, GHQ-12)
Psoriasis severity (SAPASI)
Park 201278Physical symptoms (PILL, MDASI)
Anxiety/depression (HADS)
Pauley 201182Expressiveness (ARS-20)
Mental health (GHQ-12)
General QoL (QLQ-30)
Sexual Health and performance (specific measure)
Petrie 200456HIV VL (quantitative reverse-transcriptase PCR); CD4+ count (flow cytometry)Perceived stress (PSS)
Self-rated health status
Richards 200097Symptom and emotion self-report survey
Somatic and cognitive anxiety (CSAQ)
Frequency of physical symptoms (PILL)
Rickett 201166Non-specific emotional distress (K-10)
Rini 201486Relapse
Mortality
Robinson 200899Eating disorder diagnosis (QEDD)
Desired weight (BMI)
Bulimia test (BITE)
Depression (BDI)
Rosenberg 200283Immune function/disease markers (PSA levels, peripheral blood T-cell proliferation) Serum cytokine levels of TNF-α. IL-4 and IL-10Health-care utilisation (NMCUES)
Pain (BPI)
Health-related functioning and QoL (MOS-SF-36, FACT)
Psychological symptoms (SCL-90-R; Brief POMS)
Rumination (Rumination scale)
Coping (The Ways of Coping-Cancer Version)
Sharifabad 2010105Exercise capacity (6MWD), lung function through spirometry (FEV1, FVC)QoL (CRQ)
Impact on overall health, daily life and perceived well-being (SGRQ)
Subjective feeling of shortness of breath (MMRC dyspnoea scale)
Sloan 201270PTSD diagnostic status (CAPS)
Self-reported emotion (SAM)
Prior trauma exposure (TLEQ)
Smyth 1999107Lung function through spirometry (FEV1), disease severity (DAS)
Smyth 2008121Cortisol (saliva sample)Mood (POMS)
Positive changes (PTGI)
PTSD symptoms (PSS-I)
Stark 201057Affect (POMS)
Chronic pain experience (MPI)
Pain distress (SLESQ)
Pain Catastrophising Scale
Pain intensity/severity (DDS)
Depression (BDI-SF)
Mood/affect (POMS)
Number of health centre visits missed
Quantity of pain medications taken per month
Quantity of psychotropic medication taken per month
Tabolli 2012111Psoriasis clinical severity (PASI)Symptoms and emotions (Skindex-29 Symptoms and Emotions scales)
General health (GHQ-12, SF-36)
Psoriasis severity (SAPASI)
Taylor 200389Health status (FEV1, BMI)Perceived symptoms (PHQ)
Physical complaints (SLESQ), physical, mental health and perceived health status (SF-12)
Feasibility and acceptability of the intervention (VSQ)
Theadom 201058Lung function through spirometry (FEV1, FVC)Asthma-specific QoL instrument (Marks, SSQ Asthma, SSQ Awakenings)
Asthma control (ACT)
Asthma distress (ABP)
Beta-agonist use
Corticosteroids use
Number of visits to the clinician (%)
Van Dam 201392PDS
Number of abstinent days
Vedhara 2007112Psoriasis clinical severity (PASI)Skin condition consequences in QoL (DLQI)
Mood (POMS, HADS)
Wagner 201073Affect [PANAS-X(a)]
Stress (PSS)
Optimism (HIV-OS)
Coherence (SOC)
HIV – QoL (MOS-HIV)
Walker 199979Affect [PANAS-X(a)]
Intrusive thoughts and avoidance (IES)
Wallander 2011109GI pain frequency (the Abdominal Pain Frequency Rating)
Somatisation severity (the Children’s Somatisation Inventory)
QoL (PedsQL)
GI clinic outpatient visit
Warner 2006108Lung function through spirometry (FEV1)Asthma symptoms (ASS)
Affect [PANAS-X(c)]
Behavioural disability (FDI)
Internalising behaviour problems (CBCL)
Adherence rate to the writing assignments
Wetherell 2005117RA severity (swollen and tender joint count), physician global rating of disease activity (100-mm VAS)
Disease activity (DAS)
ESR, CRPMood (POMS-SF)
Willmott 2011104Cardiac symptoms (SBP and DBP)QoL (MOS-SF-36)GP and attendance at cardiac rehabilitation sessionsAdherence to writing instructions
Zakowski 200484Personality factors (NEO-FFI)
Distress symptoms (BSI, GSI)
Intrusive thoughts and avoidance (IES)
Positive and negative moods (POMS-SV)

6MWD, 6 Minutes’ Walk Distance; ABP, Asthma Bother Profile; ABS, Affects Balance Scale; ACT, Asthma Control Test; ADSEI, Adult version of the Coopersmith Self-Esteem Inventory; AE, adverse event; ARS-20, Assertiveness/Responsiveness scale; ASS, Asthma Sum Scale; BAS-G, Bath Ankylosing Spondylitis Disease Global Score; BASDAI, Bath Ankylosing Spondylitis Disease Activity Index; BITE, Bulimia Investigatory Test Edinburgh; BMI, body mass index; Brief COPE, Brief Coping Inventory; BSCS, Brief Substance Craving Scale; CAPS, Clinician-Administered Post-traumatic Stress Disorder Scale; CLINHAQ, Clinical Health Assessment Questionnaire; CRQ, Chronic Respiratory Disease Questionnaire; CT3, catastrophising (maladaptive coping); DASS, Depression Anxiety Stress Scales; DBP, diastolic blood pressure; DDS, Descriptor Differential Scale; DIS, Perception of Disclosure scale; DLQI, Dermatology Life Quality Index; DS-14, Type D scale-14; FACIT-Sp, Functional Assessment of Chronic Illness Therapy, meaning/peace subscale; FACT-General, Functional Assessment of Cancer Therapy Questionnaire–General; FDI, Functional Disability Inventory; FIQ, Fibromyalgia Impact Questionnaire; FLZ, Fragebogen zur Erfassund des Lebenszufriendenheit (Life Satisfaction Scale); FSS, Fatigue Severity Scale; IBS-QoL, Irritable Bowel Syndrome Quality of Life; IES-R, Impact of Event Scale-Revised; IL-4, interleukin 4; IL-10 interleukin 10; IS, Insight Scale; LOT, Life Orientation Test; Mac New HRQOL, Mac New Health Related Quality Of Life scale; Marks, Marks Asthma Quality of Life Questionnaire; McGill Pain Q-SF, McGill Pain Questionnaire-Short Form; McGill QOL, McGill Quality Of Life; MIDAS, Migraine Disability Assessment Scale; MMRC, Modified Medical Research Council, dyspnoea scale; MMSE-K, Mini Mental State Examination Korean Version; MOS-HIV, Medical Outcomes Study HIV Health Survey; MSPSS, Multidimensional Scale of Perceived Social Support; NA, not applicable; NEO-FFI, NEO-Five Factor Inventory; NMCUES, National Medical Care Utilisation Expenditure Survey; PAID, Problem Areas in Diabetes scale; PANAS-X, Positive and Negative Affect Schedule – Expanded Form; PANAS-X(a), Positive and Negative Affect Schedule; PANAS-X(b), Positive and Negative Affect Schedule – Expanded Form; PANAS-X(c), Positive and Negative Affect Schedule for Children; PANAS-X(d), Positive and Negative Affect Schedule – Abbreviated version of the expanded version; PAS, Posttraumatic Stress Diagnostic Scale; PCR, polymerase chain reaction; PDS, Posttraumatic Stress Diagnostic Scale; PedsQL, Paediatric Quality of Life; PHQ, Patient Health Questionnaire; POMS-SV, Profile of Mood States Short Version; POMS-v, Profile of Mood States vigour subscale; PSC, Paediatric Symptom Checklist; PSC-Y, Paediatric Symptom Checklist Youth Report; PSS-I, Post-Traumatic Stress Disorder Symptom Scale Interview; PTGI, Post-Traumatic Growth Inventory; QLQ-30, Quality of Life Questionnaire; QOL, Quality of Life Scale; QoLI, Quality of Life Inventory; RSQ, Recovery Style Questionnaire; SAM, Self-Assessment Manikin; SBP, systolic blood pressure; SDSCA, Summary of Diabetes Self-Care Activities scale; SF-12, Short Form questionnaire-12 items (brief version of the SF-36); SF-36v2, Short Form questionnaire-36 items, version 2; SGRQ, St George’s Respiratory Questionnaire; SIP, Sickness Impact Profile; SLESQ, Stressful Life Events Screening Scale; SOPA, Survey Of Pain Attitudes; SSQ Asthma, Wasserfallen Symptom Score Questionnaire, asthma subscale; SSQ Awakenings, Wasserfallen Symptom Score Questionnaire, awakenings subscale; STAI-S, State/Trait Anxiety Scale, state subscale; TLEQ, Trauma Life Experience Questionnaire; VAS, visual analogue scale; WHYMPI, West Haven-Yale Multidimensional Pain Inventory.

Outcomes measures definitions

TABLE 106

Outcome measures from included studies: acronyms and definitions

AcronymDefinitions given in the primary studiesScale and scoringMeaning
6MWDChanges in 6 Minutes’ Walk Distance (6MWD) over the study periodValues are given in metresThe longer the distance in the 6MWD, the higher the performance
ABPThe Asthma Bother Profile (ABP) is a 23-item self-administered questionnaire (Hyland et al.162) designed to measure level of distress caused by asthma. It covers two domains: distress and asthma management measured with a unidimensional scale6-point Likert scale with 0 (no) and 5 (yes); with use of 0–5 scale. All scores are added up with a maximum of 75 and minimum of 0Higher scores indicate higher distress caused by asthma
ABSThe Affects Balance Scale (ABS; Bradburn163) is a self-reported measure, which rates the degree to which participants experienced 20 positive and 20 negative emotions during the past week through two subscales: Positive Affect Scale (PAS) and Negative Affect Scale (NAS). It is a 10-item outcome measure: it contains five statements reflecting positive feelings and five statements reflecting negative feelingsAn affect balance score is calculated based on the difference between the number of yes responses to positive-feeling questions minus the number of yes responses to negative-feeling questionsThe greater the score difference, the higher the affect unbalance
Abdominal pain frequencyStomach pain frequency was rated when it was sufficiently bad not to pursue with normal activityFrom 0 to 5
With 0 (not at all), 1 (once), 2 (once a week), 3 (about two or three times a week), 4 (about every other day), 5 (every day)
Higher scores indicate more frequency of abdominal pain
ACTThe Asthma Control Test (ACT), a five-question survey (with 4-week recall) on symptoms and daily functioning, which is self-administered by the patient to measure asthma control in individuals of ≥ 12 years. The survey measures the elements of asthma control as defined by the National Heart, Lung, and Blood Institute: frequency of shortness of breath and general asthma symptoms, use of rescue medications, the effect of asthma on daily functioning, and overall self-assessment of asthma control. ACT is clinically validated by specialist assessment and spirometry (www.thoracic.org/assemblies/srn/questionaires/act.php)5-point scale for symptoms and activities from 1 (all the time) to 5 (not at all); for asthma control rating from 1 (not controlled at all) to 5 (completely controlled). The scores range from 5 (poor control of asthma) to 25 (complete control of asthma)Higher scores reflecting greater asthma control. An ACT score of > 19 indicates well-controlled asthma
AdherenceSelf-reported adherence in the study by Mann72 was measured using the general measure of adherence from the RAND Medical Outcomes Study. It consists of five items6-point Likert scale ranging from 1 (none of the time) to 6 (all of the time)NA
ADSEIAn adult version (Ryden164) of the Coopersmith Self-Esteem Inventory (SEI; Coopersmith165): test–retest reliability and social desirability
The Coopersmith Self-Esteem Inventory (SEI): 58 short statements that are answered by checking the box like me or unlike me. These items consist of 50 self-esteem items and eight items that compose a lie scale, anxiety, depression, behavioural problems and physical well-being
The test has a built-in lie scale that helps to determine if the participant is trying too hard to appear to have high self-esteemThe higher the number of like me, the greater the participant’s self-reports are markedly influenced by the social desirability factor
AEEThe Ambivalence Emotional Expression (AEE; King and Emmons166) Questionnaire is a 28-item questionnaire used to assess the extent to which participants feel uncomfortable or regret expressing their emotions (e.g. I’d like to talk about my problems with others but at times I just cannot, I feel guilty after I have expressed anger to someone)The test predicts more benefit from disclosure NA
AIMS2The Arthritis Impact Measurement Scale-2 (AIMS2) is a 28-item scale that surveys the effects of arthritis on multiple domains of functioning during the previous month. It uses six subscales: mobility level (e.g. you were in bed or chair for most of the day), walking and bending (e.g. you had trouble either bending, lifting, or stooping), hand and finger function, arm function, self-care tasks, and household tasks. In the study by Lumley et al.115 they analyse two scales: (1) physical dysfunction, which assesses dysfunction in mobility, walking/bending, hand and finger function, arm functioning, ability to perform household tasks, and self-care; and (2) affective disturbance, which assesses both anxious and depressive symptoms5-point scale with respect to the frequency (number of days in a week) that a particular behaviour or symptom was experienced from 1 (all days) to 5 (no days). Ratings are averagedHigher scores indicate greater dysfunction
AIMS2: lack of social support subscaleThe 4-item subscale from the AIMS2 assesses one’s perceptions that family and friends are available if needed, are sensitive to needs, interested in helping, and understand the effects of the FM. Items were rated regarding how frequently support is availableFrom 1 (all days) to 5 (no days) and averagedHigher values indicate less social support
AIMS2: pain subscaleThe 5-item pain subscale from the AIMS2, a widely-used instrument that measures health status in rheumatic diseases during the past month. Items were worded for FM rather than arthritis (e.g. you had severe pain from your FM)5-point scale from 1 (all days) to 5 (no days), reverse scored and averagedHigher values indicate more pain
AIMS2 for physical dysfunctionThe AIMS2 was used and assessed 28 items from six subscales: mobility level (you were in bed or chair for most of the day), walking and bending (you had trouble either bending, lifting, or stooping), hand and finger function, arm function, self-care tasks and household tasks5-point scale from 1 (all days) to 5 (no days) and scoredHigher scores indicate greater physical dysfunction
ARS-20The Assertiveness/Responsiveness scale (ARS-20; Richmond and McCroskey167) is a 20-item scale consisting of two subscales, one for each trait, with 10 items eachBoth scales ask respondents to rate how much they identify with a list of representative behaviours. Behaviours for the Assertiveness scale include items like defend own beliefs and have strong personality, whereas items from the Responsiveness scale include items such as sympathetic and sensitive to the needs of othersHigher scores indicate greater levels
ASSThe Asthma Sum Scale (ASS) is a 9-item scale used to report both asthma and nasal or allergy symptoms during the past 2 weeks5-point scale from 0 (none) to 4 (severe)Higher scores indicate greater symptoms
BA useBeta-agonist use, measured as puffs per dayNumbers of puffs per day were summed upHigher number of puffs indicated greater symptoms
BAIThe Beck Anxiety Inventory (BAI; Beck and Steer168) is a 21-item self-report measure that uses a 4-point Likert scale with ratings from not at all to severely to measure physical and cognitive symptoms of anxietyEach BAI item is rated on a 4-point scale: 0 (not at all) to 3 (severely, I could barely stand it)Higher total scores indicate more severe anxiety symptoms
BAS-GThe Bath Ankylosing Spondylitis Disease Global Score (BAS-G; Jones et al.169) requires patients to respond to two questions regarding the effect of their disease on their health: over the past week, and over the past 6 months. Responses to these scales are indicated by marking a line on a 100-mm VASScale 0–10 VAS, best 10
Total score range from 0 to 10
Higher scores indicate greater effect of AS on the patient’s life
BASDAIThe Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) comprises six questions relating to individual domains of fatigue, spinal pain, joint pain and symptoms, together with perception of pain relating to bony areas of the body and to morning stiffness
BASFI comprises 10 questions regarding function in AS and ability to meet the physical demands of everyday life. Responses to these scales are indicated by marking a line on a 100-mm VAS
Scale 0–10 VAS, best 10
Total score ranges from 0 to 10
Higher scores indicate higher levels of disease activity
BASFIThe Bath Ankylosing Spondylitis Disease Functional Index (BASFI; Calin et al.170). Responses to these scales are indicated by marking a line on a 100-mm VASScale 0–10 VAS, best 10
Total score range from 0 to 10
Higher scores indicate to greater limitation of function
BDIThe Beck Depression Inventory (BDI; Beck et al.171). The full BDI has 21 items, which stress cognitive symptoms of depression, each with four Guttman-type responses choices in the form of statements, ranked in order of severity. In some categories, two alternative statements are assigned the same scoreScale 0–3, reflecting severity
Total scores range from 0 to 63
Higher total scores indicate more severe depressive symptoms
BDI-IIThe revised Beck Depression Inventory (BDI-II; Beck et al.172) is a 21-item self-report measure incorporating cognitive, affective and somatic aspects of depressed mood. In this revised version, there is one alternative score for each level (so no statement is assigned the same weight)Four alternatives for the 21 items ranging from 0 (low) to 3 (high). Total scores range from 0 to 63Higher total scores indicate more severe depressive symptoms
BDI-SFThe short 13-item version of Beck Depression Inventory (BDI-SF; Beck et al.173 and Furlanetto et al.174) measures depressive symptoms during the last 7 daysNAHigher total scores indicate more severe depressive symptoms
BFIThe Brief Fatigue Inventory (BFI; Mendoza et al.175) is a 10-item questionnaire asking participants to rate the severity of their fatigue and the degree to which it interferes with their lives. BFI has been specifically developed for cancer patient populationsResponse to the first question, ‘Are you usually tired?’ is either yes or no. The remaining nine items are measured on a 11-point Likert scale ranging from 0 (no fatigue) to 10 (worst that you can even imagine). Individual scores are added up in a total scoreHigher scores indicate worse fatigue, and a score of > 3 indicates clinically significant fatigue
BITEThe Bulimia Investigatory Test Edinburgh (BITE; Henderson and Freeman176). This 33-item scale provides a rating of symptoms of BN and BED, and has a symptom and severity subscale. BITE was used to measure symptoms over the past month, as a response to treatment. The symptom scale comprised 27 items and the severity scale comprised three items
  • Items 1, 13, 21, 23 and 31 in the symptom scale scored one point for a no response and the remaining 25 items scored one point for a yes response. The maximum possible score is 30
  • Items 6, 7 and 27 constitute the severity scale. The total score is the sum of the numbers corresponding to the circled responses
Scorers on this scale can be subdivided into three main groups: high scorers with a score of ≥ 20, medium scorers with a score of 10–19, and low scorers with a score of < 10
  • A symptom score of > 20 indicates a highly disordered eating pattern and the presence of binge eating
  • A symptom score in the medium range (10–19) suggests an unusual eating pattern but not meeting criteria for a diagnosis of bulimia
  • A symptom score in the 15–19 range may well reflect a subclinical group of binge-eaters, either in the initial stages of the disorder or a recovered bulimic
  • A symptom score in the low range (0–10) falls within normal limits
  • A severity score of > 5 is clinically significant
  • A severity score of > 10 indicates high degree of severity
BMIIn the study by Taylor et al.,89 the body mass index (BMI) was recorded as kg body weight (kg)/height (m2)NAA reduction in the BMI indicated disease progression and/or exacerbation
BPIThe Brief Pain Inventory (BPI), short form, is a 11-item self-report rating scale using simple numeric rating scales to assess the severity of pain (four questions) and impact of pain (seven questions)From 0 to 10Higher scores indicate greater pain
Brief COPEThe Brief COPE is a 28-item measure of 14 coping responses (Carver177). The responses can be categorised as adaptive coping (e.g. active coping, planning, use of emotional support) and maladaptive coping (e.g. denial, self-blame and behavioural disengagement)5-point Likert scale ranging from 1 (I haven’t been doing this at all) to 5 (I have been doing this a lot)
Items are calculated into 14 separate indices
Higher scores indicate greater active coping
Brief POMSThe Brief Profile of Mood States (Brief POMS) provides a summary measure of distress or mood. The original 65-item POMS has been widely used with cancer patients5-point Likert scale ranging from 0 (not at all); 1 (a little); 2 (moderately); 3 (quite a bit); 4 (extremely)Higher scores indicate higher distress 
BSCSThe Brief Substance Craving Scale (BSCS) is a 12-item self-report instrument assessing intensity, frequency and length of craving over a 24-hour period for substances of abuse. Each of the three items is related to the intensity, frequency and length of craving during the prior 24 hours. In Grasing et al.,90 the reductions in craving intensity were measured and those are calculated by subtracting baseline measures recorded during screening from results obtained at the initial outpatient visit5-point Likert scale ranging from 0 (not at all) to 4 (extremely). The total score ranges from 0 to 12Higher scores indicate higher craving
BSIThe Brief Symptom Inventory (BSI; Derogatis and Melisaratos178) is a 53-item scale, a shortened version of the SCL-90 (Symptom Checklist-90) that assesses nine symptoms of distress and provides three global distress indices. The BSI measures symptoms associated with distress on nine symptom dimensions (including somatisation, obsessive–compulsive, interpersonal sensitivity, depression, anxiety, hostility, phobic anxiety, paranoid ideation and psychoticism). Participants report the extent to which they experienced each of the symptoms in the past week including today. The scale also includes a global index of distress, the Global Severity Index (GSI) used in both studies by Zakowski et al. published in 200484 and 2011161Likert-type scale ranging from 0 (not at all) to 4 (extremely)Higher scores indicate higher symptoms 
C-QoLCancer Quality of Life (C-QoL; Lee179) is a cancer-specific type of QoL measurement tool developed in Korea to better reflect the cultural characteristics of the country. The C-QoL was used in Park and Yi78 and consists of 21 items with specific questions: physical conditions (n = 6), emotional states (n = 6), social role (n = 3), social status (n = 3) and coping ability (n = 4)5-point scale (0 = not at all, 1 = a little yes, 2 = moderate, 3 = quite a lot and 4 = very much so)
Range from 0 to 84
Higher scores indicate greater QoL
CAPSThe Clinician-Administered PTSD Scale (CAPS; Weathers et al.180) used to assess PTSD symptom severity. CAPS rates the frequency and intensity of each symptom along 5-point ordinal scales, the impact of symptoms on the patient’s social and occupational functioning, the overall severity of the symptom complex, and the global validity of ratings obtained. There is a total score for the CAPS PTSD ratings (frequency and intensity). The CAPS yields both dichotomous (i.e. present or absent) and continuous (i.e. severity) scores for each symptom and for the disorder as a whole5-point scale ranging from 0 to 136Higher scores indicate greater severity of PTSD symptoms
CBCLThe Child Behavior Checklist (CBCL) and by youth on the Youth Self-Report of the CBCL (Achenbach181) consists of 113 questions used to detect emotional and behavioural problems in children and adolescents3-point Likert scale ranging from 0 (absent), 1 (occurs sometimes), 2 (occurs often)Higher scores indicate more emotional and behavioural problems
CD4+ countCD4+ lymphocyte count was determined by flow cytometry. A square root transformation was used on the CD4+ counts to give an approximately normal distribution. Data were analysed as a multivariate hierarchical model using the hierarchical linear modelling programme HLM 5.04. In Ironson et al.,71 flow cytometry was performed in one laboratory to enumerate CD3+/CD4+ lymphocytes with fluorochrome conjugated monoclonal antibodies in a four-colour systemThreshold used in the study was not reported but used as a predictor of disease progressionHigher count in CD4+ cells when associated with improved immune status and better health
CDIThe Children Depression Inventory (CDI) contains 27 items that represent a range of depressive symptoms including disturbed mood, hedonic capacity, vegetative functions, self-evaluation and interpersonal problems. The child is asked to choose the item that best describes him or her for the past 2 weeks. The five factors for the CDI are negative mood, interpersonal problems, ineffectiveness, anhedonia and negative self-esteemEach item consists of three statements that are keyed 0, 1 or 2Higher scores indicating increased severity
CES-DThe Centre for Epidemiological Studies Depression Scale (CES-D; Radloff182) is a 20-item scale; participants rated the intensity and frequency of depressive symptoms they had experienced in the past week. The CES-D has been used to measure clinical and subclinical levels of depression in medical populations and effectively identifies depression among patients with chronic pain (Geisser et al.183). It includes four factors: dysphoria, positive affect, a somatic factor, and an interpersonal factor. In Henry et al.,53 four subscales were calculated from the CES-D: depressed mood (seven items, α = 0.83–0.92), (lack of) positive affect (four items, α = 0.71–0.9), somatisation or retarded activity (seven items, α = 0.5–0.9), and (lack of) interpersonal relations (two items)4-point Likert-type scale from 0 (rarely or none of the time) to 3 (most or all of the time)Higher scores indicates the greatest frequency of depressed mood over the past week
CG-FBDThe functional bowel disease-related cognition consisted of CG-FBD Q16 My bowel symptoms make me feel out of control and CG-FBD Q31 Nothing seems to help my bowel symptomsScale 0–7, worse cognition 7Higher scores indicate worse adaptive cognition
CLINHAQThree items from the Clinical Health Assessment Questionnaire (CLINHAQ; Wolfe184) were used in Broderick et al.118 to assess GI, headache and fatigue symptoms. The CLINHAQ contains self-reports for the Health Assessment Questionnaire (HAQ; Fries185) disability index, Arthritis Impact Measurement Scale (AIMS) anxiety and depression index (Hawley and Wolfe186), VAS pain, VAS global severity, VAS GI symptoms, VAS sleep problems, VAS fatigue, satisfaction with health, and patient estimate of health status. In 1996, the helplessness subscale of the RAI was added to the CLINHAQ (deVellis et al.187). The variables contained in this questionnaire consider factors that are thought to be of major importance in FM (Burckhardt et al.188)On a 100-point VASHigher scales indicate greater symptoms
CortisolCortisol reactivity was assessed in Smyth et al.9 by asking participants to collect saliva by placing a sterile cotton wad in their mouth for a few minutes and then sealing the cotton in a salivette, a test tube-like container (Sartstedt, Rommelsdorf, Germany). Samples were kept frozen until shipped for assay at a clinical laboratoryCortisol levels were assessed in response to imagery-based trauma re-exposureLower levels indicate greater health improvement
CRPThe C-reactive protein (CRP), which is another serum measure of inflammation, was measured in Wetherell et al.117 CRP is an acute phase protein, levels of which fluctuate over a shorter time period than ESR (Kushner189). CRP therefore provides an objective marker of disease activity in addition to the components of the DASCRP is a measure of inflammation and provide markers for clinical status in rheumatic disease. CRP is sensitive and is only raised during periods of acute inflammationHigher CRP levels indicate greater transitory acute inflammation
CRQThe Chronic Respiratory Disease Questionnaire (CRQ) is an interviewer-administered questionnaire measuring both physical and emotional aspects of chronic respiratory disease. It has 20 questions in four categories: dyspnoea, fatigue, emotional function and mastery7-point scale, with 7 indicating no health impairment. A change of 0.5 for each is considered the minimal clinically significant changeHigher scores indicate better HRQoL
CS useCorticosteroid use, measured as puffs per dayCS use is an indicator of disease statusThe higher the use of CS, the worst the disease course
CSAQThe Cognitive-Somatic Anxiety Questionnaire (CSAQ; Schwartz190) a trait anxiety inventory, is a 14-item self-report inventory that is divided into two 7-item scales (cognitive and somatic) that appear to reflect cognitive or somatic anxiety. Participants are asked to rate the degree to which they are generally or typically experiencing symptoms of anxiety by circling a number from 1 through to 55-point Likert scale ranging from 1 (not at all) to 5 (very much so). The sums of the circled rating are separately computed for the cognitive and somatic items, and constituted the main dependent measuresHigher total scores indicate higher symptoms
CSIThe Children’s Somatisation Inventory (CSI) includes 36 symptoms from the criteria for Somatisation Disorder and the Somatisation factor of the Hopkins Symptom Checklist. Ratings are obtained on the severity with which the youth have experienced each symptom (e.g. headaches, pains in the heart, muscle aches) in the past 2 weeks5-point scale from 0 (not at all) to 4 (a whole lot). A total score was calculated in the standard fashion to measure severity of general somatisation symptomsHigher scores indicate higher severity of symptoms
CT3Catastrophising (maladaptive coping)Scale 0–36; worse catastrophising, 36Higher scores indicate worse catastrophising
DASThe Disease Activity Score (DAS) involves measurement of four variables: counts of the number of swollen and tender joints (assessed by physical examination); a patient self-report measure (All things considered, how are you feeling?), measured using a 100-mm VAS; and a serum measure of inflammation, i.e. ESR. ESR is an indirect measure of acute phase reactions and provides a standardised and validated clinical index for assessing disease activity in RA (Fuchs191). A total score can be computed or individual components of the DAS can be usedThe DAS ranges from 2 to 10Scores of < 2.6 indicate disease remission and scores of > 5.1 indicate high disease activity
DASSThe Depression Anxiety Stress Scales (DASS) is a 42-item self-report measure used to assess depression, anxiety and stress in clinical samples over the previous week4-point Likert scale from 0 (did not apply to me at all) to 3 (applied to me very much, or most of the time)Higher scores indicate greater symptoms
Davidson PTSD scaleThe Davidson PTSD scale (PTSDTOT; Davidson et al.,192 Zlotnick et al.193) is a 17-item, interview-administered measure based on the PTSD symptom clusters defined by DSM-IV. Respondents are asked to rate each of the 17 items referring to a particular traumatic event, or series of events, according to level of distress based on their ratings of symptoms that have occurred during the past week. Both frequency and severity are rated for each item. If the respondent has experienced multiple traumatic episodes, multiple copies of the scale may be administeredFrom 0 to 4 for both frequency and severity during the past week
Items are summed for a total score, and subscales measure re-experiencing, avoidance and arousal
Higher scores indicate greater symptoms
DBPDiastolic blood pressure (DBP), measured in mmHgBP is indicative of chronic complications post MI, such as cardiac arrhythmias and left ventricular failureHigher DBP indicated greater post-MI complications
DISThe Perception of Disclosure Scale (DIS) measures the perception of the extent to which participants had already expressed their deepest thoughts and feelings about their cancer experience through writing or discussion with othersScale ranges from 0 (not all) to 10 (complete disclosure)Higher scores indicate more complete disclosure
Disease Activity Rating ScaleThe Disease Activity Rating Scale is a scale used by physicians to indicate the current status of the patient’s RA. Factors that physicians would take into account in making this rating include number of tender and swollen joints, and degree of inflammation and pain5-point rating scale ranging from 0 (asymptomatic) to 4 (very severe)
A 1-point change is considered clinically significant
Higher scores indicate greater disease activity
DLQIThe Dermatology Life Quality Index (DLQI; Finlay and Khan194) is used widely in patients with dermatological conditions, including psoriasis. It examines respondents views on the functional consequences of their skin condition on their lives in the previous week. It correlates well with clinical measures of disease severity and boasts of good reliability statistics. It measures how much the skin problem has affected your life. It is designed for young people aged > 16 years and for adults4-point Likert scale ranging from very much to not at all
The scoring is:
  • Very much scored 3
  • A lot scored 2
  • A little scored 1
  • Not at all scored 0
  • Not relevant scored 0
  • Question 7, prevented work or studying scored 3
The DLQI is calculated by summing the score of each question, resulting in a maximum of 30 and a minimum of 0
The higher the score, the more QoL is impaired
DS-14The DS-14 is a 14-item measure of negative affectivity (seven items) and social inhibition (seven items) (Denollet195)
The DS-14 has good psychometric properties and is widely used with cardiac populations (e.g. Denollet et al.196)
5-point Likert scale from 0 to 4A score of ≥ 10 on both the negative affectivity and social inhibition scales indicates Type D personality
DTThe Distress Thermometer (DT; Roth et al.197) assessed general distress11-point Likert scale from 0 (no distress) to 10 (extreme distress)Higher scores indicate greater distress
Emotional approach copingIn Averill et al.,100 the emotional approach coping (Stanton et al.198) was measured to assess emotional processing (four items: e.g. I take time to figure out what I am really feeling; α = 0.76) and emotional expression (four items; e.g. I feel free to express my emotions; α = 0.89). Because the two subscales were correlated only 0.61, they were used separately in analysis8-item scaleLower emotional approach copying are related to lower psychological well-being
EQ-5DQoL measured by utility and VAS. A measure of perceived health statusUtility: 0–1, where 0 is death and 1 is perfect perceived health
VAS: 0–100, where 0 is death and 100 is perfect perceived health
Higher scores indicate better health
ESRThe erythrocyte sedimentation rate (ESR)ESR is an indicator of inflammation and disease activityValues of > 20 mm/hour indicate elevated inflammation and disease activity
Expressed angerIn Graham et al.,51 the degree of express anger was uniquely accounted for intervention effects and meaning making mediated effects on depressed moodFrom 0 (none) to 4 (very much)
A code of 4 was given when the letter included an explicit statement indicating that the participant was, for instance, very angry or furious or if the participant had used many examples that sounded frustrating and/or used underlining, exclamation points, or other techniques for emphasis
A code 0 was given when the participant neither identified at all with an anger-related emotion (including frustration) nor gave any examples that seemed frustrating
Higher scores indicate higher expression of anger
FACIT-FThe Functional Assessment of Chronic Illness Therapy Fatigue subscale version 4 (FACIT-F; Yellen199) assessed fatigue during the past 7 days. It measures physical well-being, social/family well-being, emotional well-being, functional well-being and additional concernsAll items are measured on a 5-point Likert scale ranging from 0 (not at all) to 4 (very much)Higher scores indicate greater fatigue
FACIT-SpThe meaning/peace subscale of the Functional Assessment of Chronic Illness Therapy–Spiritual Well-Being scale (FACIT-Sp; Peterman et al.200)
A 12-item self-report measure comprises two subscales: one measuring a sense of meaning and peace and the other assessing the role of faith in illness
A total score for spiritual well-being is produced. In Mosher et al.,77 the FACIT-Sp is used to measure existential well-being by assessing participant’s degree of purpose in life and inner peace
Scale ranging from 0 to 48
Two subscales:
  • Meaning/peace (items 1–8)
  • Faith (items 9–12)
Higher scores signifying greater spiritual well-being
FACT-GeneralThe Functional Assessment of Cancer Therapy (FACT; Basen-Engquist et al.201) questionnaire is a 34-item general cancer QoL measure for evaluating patients receiving cancer treatment. It covers five general cancer-related domains (physical well-being, social family well-being, relationship with health-care provider, emotional well-being, and functional well-being) and one disease/site-specific domain5-point scale from 0 (not at all) to 4 (very much)Higher scores indicate better QoL
FACT-BThe Functional Assessment of Cancer Therapy-Breast Cancer Version (FACT-B) is a 37-item self-report instrument, with known validity and reliability, containing 27 general items (from the FACT-General) plus 10 breast cancer-specific items (Brady et al.202)
Subscales include physical well-being (seven items), social/family well-being (seven items), emotional well-being (six items) and functional well-being (seven items)
The 10 additional items address physical and psychological concerns related to breast cancer
Respondents are asked to rate how true each statement had been for them over the past 7 days
5-point Likert-type scale from 0 (not at all) to 4 (very much). All 37 items can be combined for a total QoL score, and subscale scores may be computed as wellHigher scores indicate higher QoL
FDIThe Functional Disability Inventory (FDI; Walker and Greene203) is a 15-item assessing difficulty performing various routine behaviours during the last few weeksItems range from 0 (no trouble) to 4 (impossible) and totalledHigher scores indicate greater disability
FEV1The forced expiratory volume in 1 second (FEV1)FEV1 is one of the primary indicators of health status and disease progression for cystic fibrosis or patients with asthma, for instanceA decrease in FEV1 indicates disease exacerbation and/or reduction of lung functioning
FIQThe Fibromyalgia Impact Questionnaire (FIQ) evaluates the global health status using a 10-item survey assessing those components of health that are most affected by FM (physical functioning, work status, depression, anxiety, sleep, pain, stiffness, fatigue and well-being) during the prior week
FIQ is an adaptation of the HAQ and the AIMS
In Broderick et al.,118 items assessing physical functioning and stiffness were used
Scores range from 0 to 100Higher scores indicate poorer health or functioning
FLZThe Fragebogen zur Erfassung des Lebenszufriendenheit (FLZ) is a Life Satisfaction Scale used to measure life satisfaction
The FLZ uses eight items assessing patient’s satisfaction with different areas of their life (e.g. social contacts, partnership, financial situation)
7-point Likert scale from 1 (very satisfied) to 7 (very unsatisfied)
The sum score indicates overall life satisfaction
Higher scores indicate less life satisfaction
FSSThe 9-item Fatigue Severity Scale (FSS) assesses the frequency and severity of fatigues interference with physical functioningItems were rated on a 1–7 scale and averagedHigher scores indicate greater fatigue
FVCThe forced vital capacity (FVC)FVC is one of the primary indicators of health status and disease progression for cystic fibrosis or patients with asthma, for instanceA decrease in FVC indicates disease exacerbation and/or reduction of lung functioning
GBBThe Giessener Beschwerdebogen (GBB) is a 24-item scale assessing various symptomatic complaints
The sum score measures subjective physical well-being
5-point Likert scale ranging from 0 (not applicable) to 4 (strongly)
The total score ranges from 0 to 12
Higher scores indicate greater symptoms, decreased subjective physical health
GDSThe Geriatric Depression Scale (GDS; Yesavage et al.204) is a 30-item scale that is more appropriate for use with people with ALS than other depression instruments that include somatic symptoms regularly experienced in ALS
  • A score of > 5 points is suggestive of depression
  • A score of ≥ 10 points is almost always indicative of depression
  • A score of > 5 points should warrant a follow-up comprehensive assessment
Higher scores indicate higher symptoms of depression 
GHQ-12The General Health Questionnaire (GHQ-12; Goldberg et al.205) was used as an indicator of overall mental health in hundreds of studies that assessed both clinical and non-clinical populations
Items from the GHQ-12 included: Have you recently been able to concentrate on what you are doing? Have you been able to face up to your normal problems?
Owing to the various thresholds of the GHQ-12, the mean GHQ score for a population of respondents was suggested as a rough indicator for the best cut-off point (Goldberg et al.206). Therefore, based on the mean GHQ score for this sample, the cut-off point is used to determine the respondent’s level of psychological well-being
4-point Likert scale
The scores are summed up by adding all the items on the scale ranging from 0 to 12
NA
GSIThe Global Severity Index (GSI) is a widely used index of stress and is highly correlated with the BSI subscales. Individuals report the extent to which they experienced each of the symptoms in the past week including today5-point Likert scale
Ranges from 0 (not at all) to 4 (extremely)
Higher scores indicate greater severity 
HADSThe Hospital Anxiety and Depression Scale (HADS; Zigmond and Snaith207), which contains 14 items (seven anxiety items and seven depression items)
This scale requires participants to indicate how they have been feeling during the past week. In Wallander et al.,109 participants with a HADS total score of 15 were classified as being clinically distressed
4-point scale ranging from 0 (not at all) to 3 (most of the time)
Total score ranges from 0 to 21
Higher scores indicate higher anxiety/depression
HADS-AThe anxiety subscale of the Hospital Anxiety and Depression Scale (HADS-A; Zigmond and Snaith207)A score of 0–7 is considered to be normal
Scores of ≥ 20 indicate moderate, severe or very severe anxiety
Higher scores on each individual scale or the entire scale indicate greater anxiety or mood disorder
HADS-DThe depression subscale of the Hospital Anxiety and Depression Scale (HADS-A; Zigmond and Snaith207)A score of 0–7 is considered to be normal
Scores of ≥ 20 indicate moderate, severe or very severe depression
Higher scores on each individual scale or the entire scale indicate greater depression or mood disorder
HAM–DThe Hamilton Depression Scale (HAM–D; Hamilton208) is a 17-item, interview-based measure, considered the gold standard for assessing severity of depressionA score of 0–7 is considered to be normal
Scores of ≥ 20 indicate moderate, severe, or very severe depression
Higher scores indicate more depression or mood disorder
Headache frequencyNumber of days in the last month with a headacheNAThe higher the frequency the worst the health status
HIV symptom checklistIn Ironson et al.,71 experimenters assessed symptoms relevant to HIV (based on the Centre for Disease Control and Prevention criteria for Category B symptoms) by interview using a HIV symptom checklist
Symptoms were assessed for the previous month at baseline and the 1-month visit, and for the previous 6 months, at the 6- and 12-month visits; thus, symptoms were assessed during the complete follow-up period
Examples of symptoms are herpes zoster (shingles), oral thrush, cervical dysplasia, pelvic inflammatory disease, low platelet count (50,000), peripheral neuropathy, chronic unexplained fever and chronic unexplained diarrhoeaMore symptoms indicate a worse health
HIV VLHIV VL was determined using a quantitative reverse-transcriptase PCR assay (Amplicor HIV-1 Monitor, Roche Diagnostic Systems), which measures down to 400 copies of HIV RNA in plasmaThreshold not reportedA reduction in VL indicates better health
HIV-OSThe HIV-Specific Optimism Scale (HIV-OS) is a self-report measure of optimistic beliefs related to HIV issues
Seven items were adapted from the LOT (Scheier and Carver209) specifically for Wagner et al.73 Sample HIV-OS items include ‘I am not counting on things going my way in the course of my HIV infection’ and ‘Although the future course of my HIV infection is uncertain, I expect the best’
6-point Likert scale ranging from strongly disagree to strongly agreeHigher scores indicate higher levels of optimism related to HIV issues
IBS-QoLThe Irritable Bowel Syndrome QoLScale 0–100, best = 100Higher scores indicate better QoL
IBSSSThe irritable bowel severity (IBS) scale/scoring system (IBSSS; Francis et al.210) is a 9-item survey designed to enable clinicians to record and monitor the severity of IBS
Participants have to answer the questions based on how they feel currently (i.e. over the last 10 days or so)
A total IBS severity score is given
  • Mild severity: 75–175
  • Moderate severity: 175–300
  • Severe severity: > 300
The maximum score is 500
Higher scores indicate increase in IBS severity
IESThe Impact of Event Scale (IES; Horowitz et al.211) assesses frequency of intrusive thoughts and avoidance over the past week including today. Participants are asked to specifically refer to their cancer experience when answering the questionsResponses for each item are 0 (not at all); 1 (rarely); 3 (sometimes); 5 (often)
Possible score ranges from 0 to 40
Higher scores indicate the greater extent to which participants have experienced each item, in the preceding 7 days
IES-RThe Impact of Event Scale-Revised (IES-R; Weiss and Marmar212), which contains 22 items that measure avoidance, intrusive re-experiences and arousal associated with a traumatic event5-point scale ranging from 0 (not at all) to 4 (extremely)Higher scores indicate greater extent to which participants have experienced each item in the preceding 7 days in relation to their psychotic experiences and treatment
ISThe 8-item Insight Scale (IS; Birchwood et al.213), which measures three dimensions of insight: perceived need for treatment, awareness of illness and relabelling of symptoms as pathologicalResponse to each item reported as agree, disagree or unsureNA
K-10The Kessler Psychological Distress Scale (K-10) detects non-specific emotional distress and has been used in a number of population health surveys in Australia. It contains 10 statements covering the preceding 4 weeks5-point Likert scale from 1 (none of the time) to 5 (all the time)
Possible scores range from 10 (no distress) to 50 (maximal distress)
Higher scores indicate higher distress
LIFEThe Longitudinal Interval Follow-Up Evaluation (LIFE; Keller et al.214) is a semistructured interview for assessing the longitudinal course of psychiatric disorders
It consists of a semistructured interview, an Instruction booklet, a coding sheet, and a set of training materials. An interviewer uses the LIFE to collect detailed psychosocial, psychopathological, and treatment information for a 6-month follow-up interval
The weekly psychopathology measures (psychiatric status ratings) are ordinal symptom-based scales with categories defined to match the levels of symptoms used in the Research Diagnostic Criteria
The ratings provide a separate, concurrent record of the course of each disorder initially diagnosed in patients or developing during the follow-up
Any DSM-III or Research Diagnostic Criteria disorder can be rated with the LIFE, and any length or number of follow-up intervals can be accommodated. The psychosocial and treatment information is recorded so that these data can be linked temporally to the psychiatric status ratings
NANA
LIWCThe Linguistic Inquiry and Word Count (LIWC) is a text analysis software program designed by Pennebaker et al.19
LIWC calculates the degree to which people use different categories of words across a wide array of texts, including e-mails, speeches, poems, or transcribed daily speech. With a click of a button, you can determine the degree any text uses positive or negative emotions, self-references, causal words, and 70 other language dimensions (www.liwc.net/)
NANA
LOTThe Life Orientation Test (LOT) assesses generalised positive outcome experiences measures optimism on eight items to indicate the extent to which they agree with each statement5-point Likert scales ranging from 1 (strongly agree) to 5 (strongly disagree)
The items are summed to create a score ranging from 8 to 40
Higher numbers indicate more optimism
Mac New HRQOLThe Mac New Health Related Quality Of Life (Mac New HRQOL) scale is a 27-item measure of physical, emotional and social QoL (Valenti et al.215)
In addition to separate physical, emotional and social QoL subscales, an overall index of QoL is provided. It has been extensively used in cardiac populations, and based on data from over 1000 cardiac patients
7-point Likert scale. A change of 0.5 units reflects a minimal clinically important difference (Dixon et al.216)Higher scores indicate better health
MarksThe Marks Asthma Quality of Life Questionnaire (Marks; Marks et al.217) is a self-administered questionnaire intended for use with adults
Respondents are asked to describe how troubling particular items have been over the past 4 weeks. Covers both physical and emotional impact
Should not be confused with the Asthma Quality of Life Questionnaire (AQLQ; Juniper et al.218)
Scaling of items from 1 to 5NA
McGill Pain Q-SFThe McGill Pain Questionnaire-Short Form (McGill Pain Q-SF; Melzack219) assesses these two dimensions of pain, as currently experienced by the patient. It contains 11 items assessing several domains of pain experience: intensity, sensory and affectiveScale from 0 (none) to 3 (severe) scale
Ratings were averaged
Higher scores indicate greater severity
McGill QOLIn Averill et al.,100 psychological and existential QoL were measured with the McGill QOL questionnaire to assess the subjective QoL of patients with terminal illness. Psychological QoL reflects the extent to which patients have experienced symptoms of depression, anxiety, sadness and hopelessness. There were six measures of psychological well-being that were highly correlated with each other: positive affect, negative affect, depression, psychological QoL, existential QoL and spirituality
Existential QoL reflects patients’ ratings of the worth and meaning of their life, their progress towards their goals, their control over their life and the value of each day
11-point Likert scale ranging from 0 to 10
Scores are summed up into a total score
Lower scores indicate better health
MDASIThe MD Anderson Symptom Inventory (MDASI; Cleeland et al.220) is used to assess multiple symptoms experienced by cancer patients and the interference with daily living caused by these symptoms. Participants rate the severity of 13 core symptoms (in the last 24 hours) common across all cancer diagnoses and treatments and the extent to which these symptoms interfere with daily activities
In Park and Yi78 a Korean version (Yun et al.221) was adapted
From 0 (symptom has not been present) to 10 (the symptom was as bad as you can imagine it could be)Higher scores indicate greater severity and interference 
MIDASThe Migraine Disability Assessment Scale (MIDAS) is a 5-item inventory that assesses the number of days in the past month when the respondents functioning was reduced or impaired because of headaches (behavioural disability from headaches) including days of work (including housework), school or other activities missed, as well as the number of days for which productivity was reduced by half
A total of five items are calculated and analysed
The number of days is added up, totalling a final number of days from questions 1–5
MIDAS scores thresholds are as follows:
  • 0–5: no disability
  • 6–10: mild disability
  • 11–20: moderate disability
  • > 21: severe disability 
Higher scores indicate greater migraine disability
Mississippi Scale for PTSDThe Mississippi Scale for combat-related PTSD (Hebrew version) is a 35-item self-reported questionnaire describing participant’s feeling on each of the items
Items 2, 6, 11, 17, 19, 22, 24, 27, 30 and 34 are scored in reverse order
The cut-off score for PTSD is set at 107, a score that correctly classifies 90% of all subjects as PTSD or non-PTSD
Means for the three validation groups are as follows: PTSD 130 (SD = 18); psychiatric 86 (SD = 26); well adjusted 76 (SD = 18)
Each item receives a score of 1–5
Add all items to obtain the total score
A total score of > 107 indicates a diagnosis of PTSD
MMSE-KoreanThe Mini Mental State Examination (MMSE) is often taken to rate cognitive functioning difficulties in a relatively short time: in the present study, the Korean version of MMSE, named MMSE-K, was used in the included study by Hong and Choi67
The MMSE-K has 30 questions for rating and each question is counted as one point. The full score of MMSE-K is 30 points. It consists of seven subitems. The standard MMSE-K was slightly modified, combining time orientation and space orientation into orientation to which 10 points were allocated, and also unifying memory registration and memory recall to memory to which six points were allocated
Diagnostic criteria of dementia in terms of the MMSE-K score are given as follows: a total score of > 23 points is classified as normal, 20–23 points as doubted as dementia and < 20 points as dementia
The score of each item is allocated as follows: (1) 5 points for time orientation, (2) 5 points for space orientation, (3) 3 points for memory registration, (4) 3 points for memory recall, (5) 5 points for attention and calculation, (6) 7 points for language, and (7) 2 points for comprehension and judgementA total score of < 20 indicates dementia
Modified MRC dyspnoea scaleThe Modified Medical Research Council dyspnoea scale (MMRC) is an instrument to document subjective feeling of shortness of breathFrom 0 (shortness of breath only with strenuous activity) to 4 (shortness of breath with minimal activity, even dressing or undressing)Higher scores indicate higher subjective feeling of shortness of breath
MOS-HIVThe Medical Outcomes Study HIV Health Survey, a brief, multidimensional and comprehensive measure of HRQoL used extensively in HIV/AIDS research (MOS-HIV; Wu et al.222)
It measured the physical functioning, pain, and mental health using three subscales:
  • The 6-item physical functioning subscale is a self-report measure of how long one’s health has been limited in vigorous physical activities (such as lifting), moderate physical activities (such as carrying groceries) and other activities of daily living
  • The pain subscale consists of two items: amount of bodily pain and the extent to which pain interfered with normal work activities
  • The mental health subscale consists of five items: nervous, calm and peaceful, downhearted and blue, happy, and down in the dumps
  • 3-point scale: limited for more than 3 months; limited for the last 3 months and not at all limited
  • Amount of bodily pain from none to severe, and the extent to which pain interfered with normal work activities from not at all to extremely
  • Mental health subscale ranges from 1 (all of the time) to 6 (none of the time)
  • Higher scores indicate better physical functioning
  • The higher the scores on the pain subscale, the lower the pain
  • Higher mental health subscale scores indicate better mental health
MPIThe Multidimensional Pain Inventory (MPI; Kerns223) is a 48-item self-reported questionnaire, divided in three sections
In the first section, the participant responds about their pain, and how it affects their lives
In the second section, the participant responds about how his/her spouse or significant others respond to them in that particular way when they are in pain
In the third section, the participant responds to how often they do different daily tasks (such as washing dishes, going to the cinema, take a trip, or engage in sexual activities)
Participants can also list any other pain-related problem
Section 1: 7-point Likert scale ranging from 0 (not at all) to 6 (extremely)
Section 2: range from never to often
Section 3: range from never to often
The scoring procedure produces a mean score for each scale
Higher scores indicate greater pain
MSPSSThe Multidimensional Scale of Perceived Social Support (MSPSS; Zimet et al.224) is a 12-item self-report measure used to measure perceived social support7-point Likert scale from 1 (very strongly disagree) to 7 (very strongly agree)Higher scores indicate higher perceived social support
NMCUESThe National Medical Care Utilisation Expenditure Survey (NMCUES; National Centre for Health Statistics225)
It assesses multiple forms of health-care utilisation and behaviours over a period (3 months in Rosenberg et al.83)
Questions addressed health-care utilisation patterns, current use of medicines and health-related behaviours (e.g. smoking, substance use)
NANA
OQ-45.2The Outcome Questionnaire (OQ-45.2; Lambert et al.226) is a 45-item self-report measure intended for weekly assessment of client progress through the course of psychotherapy
The OQ-45.2 produces a total score and three subscale scores (symptom distress, interpersonal relations and social role)
The total score is calculated by summing the patient’s ratings across all 45 items (range 0–180)Higher scores indicate greater clinical improvement
PAIDProblem Areas In Diabetes scale (PAID; Polonsky et al.227), otherwise not describedNANA
Pain behaviourIn both included studies by Lumley et al.115 and Macklem,131 a structured observation system228 which was designed for RA patients, assessed overt pain behaviour
At each evaluation, patients were videotaped in the examination room for 10 minutes by a camera in the doorway while they engaged in four standardised manoeuvres (walking, sitting, standing and reclining), which were presented in a random order. The research assistant operated the camera and refrained from interacting with the patient other than to give directions for the next behaviour
Raters were trained to code these videotapes by the developer of the system (Francis J Keefe) and achieved high inter-rater reliability during training. Next, these raters, blind to experimental condition, reviewed study videotapes for the presence of seven pain behaviours: guarding, bracing, grimacing, sighing, rigidity, passive rubbing and active rubbing
The 10-minute tapes were divided into 20 30-second epochs; the presence or absence of each pain behaviour during each epoch was recorded, and a total score of all behaviours across all epochs was calculated
NANA
Pain intensityIn the included study by Cepeda et al.,85 patients rated their average pain intensity using a verbal numerical rating scale
In the included study by Macklem,131 pain intensity was measured using a 100-mm VAS
Verbal numerical rating scale from 0 (no pain) to 10 (the worst pain imaginable)
100-mm VAS ranges from 0 (no pain) to 100 (pain as bad it can be)
Higher scores indicate more pain intensity
PANAS-X(a)The Positive and Negative Affect Schedule (PANAS; Watson et al.229) which contains 16 items (eight positive items and eight negative items)
In Wagner et al.73 the same scale is reported as PANAS and defined as a 20-item scale with the same 5-point response options. Words that describe feelings and emotions, such as interested, distressed, and proud load on either the positive or negative affect factor (10 items each). In this study, participants were asked to rate their feelings during the past week, including today
5-point scale ranging from 1 (very slightly or not at all) to 5 (extremely)Higher scores indicate greater mood change
PANAS-X(b)The Positive and Negative Affect Schedule–Expanded Form (PANAS-X, Watson and Clark230) was applied to assess emotional states of patients: 60-item scale, which was created to assess not only general dimensions of emotional experience, but specific emotional states too
It included the original PANAS assessing short-term mood fluctuations, with consistent psychometric results in varying populations and over various time frames: this measure consists of two 10-item scales for positive and negative affect
In addition to the two original higher order scales, the PANAS-X measures 11 specific affects: joviality, self-assurance, attentiveness, fear, sadness, guilt, hostility, shyness, fatigue, serenity, surprise
5-point scale ranging from 1 (very slightly or not at all) to 5 (extremely)Higher scores indicate greater mood change
PANAS-X(c)The Positive and Negative Affect Schedule for Children [PANAS-X(c); Laurent et al.231] is a 30-item scale, through which items are rated for affect during the past few weeks and averaged separately for positive affect (PA) and negative affect (NA) measures6-point scale from 0 (very slightly or not at all) to 5 (extremely)Higher scores indicate greater mood change
PANAS-X(d)The Positive and Negative Affect Schedule–Abbreviated version of the expanded version [PANAS-X(d), Watson and Clark232] was used in the included study by D’Souza et al.101
The four negative moods were highly correlated (e.g. alpha for session 1 was 0.75 for tension and 0.73 for migraine samples), so the four ratings were averaged into one negative mood score and analysed it separately from calmness
Items rated from 1 (not at all) to 7 (a great deal) for four negative moods (anger, guilt, sadness, fear) and for calmnessHigher scores indicate greater mood change
PANAS-X NA subscaleThe 10-item negative affect subscale from the 60-item PANAS-X rated the frequency that they experienced each item during the prior 2 weeks5-point Likert scale ranging from 1 (not at all) to 5 (extremely)Higher scores indicate greater mood change
PASIThe Psoriasis Area and Severity Index (PASI; Feldman et al.233) is an internationally accepted, clinician-rated, psoriasis-specific score, based on the body surface area involved and on semi-quantitative estimation of erythema, infiltration and scaling; it is by far the most common tool in clinical studies and in daily practice. The head, trunk, and upper and lower extremities are assessedScores range from 0 (no psoriasis) to 72 (extremely severe psoriasis)Higher scores indicate greater psoriasis severity
PDSThe Posttraumatic Stress Diagnostic Scale (PDS; Foa et al.234), a 49-item self-reported measure, aids in PTSD diagnosis and symptom severity, with items that parallel DSM-IV criteria
A diagnosis of PTSD is made only when DSM-IV criteria A–F are met
The PDS includes a symptom severity score. Respondents rate 17 items representing the cardinal symptoms of PTSD experienced in the past 30 days. Finally, respondents rate the level of impairment caused by their symptoms across nine areas of life functioning
4-point scale
Scores range from 0 to 51, and this is obtained by adding up the individuals responses of selected items
The cut-off points for symptom severity rating are:
  • 0: no rating
  • 1–10: mild
  • 11–20: moderate
  • 21–35: moderate to severe
  • ≥ 36: severe
Higher scores indicate higher PTSD symptoms
PedsQLThe Paediatric Quality of Life (PedsQL) is a 23-item well-validated scale with excellent internal consistency – how much of a problem various physical activities, feelings, social situations, and school activities have been in the past month
QoL domains were restricted to (a) physical (eight items) and (b) psychosocial (15 items)
5-point scale from 0 (never a problem) to 4 (almost always a problem)Lower scores indicate better health
PSA spec – CD4+/8+Peripheral blood T-cell proliferation to specified antigens
This technique was assessed by the cell census proliferation assay method. It involves the use of a fluorescent membrane dye that partitions between daughter cells at division, in conjunction with flow cytometry to measure the proliferation of cells
With mathematical deconvolution of the fluorescence histograms, the precursor frequency of cells in the original population that responded to a specific stimulus can be derived
By using a second tagged fluorescent antibody to stain for lymphocyte subsets, the proliferation of specific phenotypes (CD4+/CD8+) of responding cells can be examined
NANA
PHQThe Patient Health Questionnaire (PHQ; Spitzer et al.,235,236) is designed as a screening instrument for use with health-care seeking populations
It provides information on perceived symptoms of (a) depression, (b) anxiety, (c) somatic complaints, and (d) psychological distress
The two subscales that measure symptoms of depression (nine items) and anxiety (15 items) employ DSM-IV criteria to screen for the presence of these psychiatric illnesses
For each item:
  • Depression scale range: from 0 to 3
  • Anxiety scale range: from 1 to 4
Depression severity:
  • 0–4: none
  • 5–9: mild
  • 10–14: moderate
  • 15–19: moderately severe
  • 20–27: severe
Physician’s global rating of disease activityIn Lumley et al.,115 the evaluating physician-rated patient’s overall disease activity with a 100-mm VAS
In Macklem,131 scoring was done on a 5-point Likert scale
From 0 to 100 VAS, with anchors of 0 (no activity) to 100 (most activity)
Range from 0 (asymptomatic), 1 (mild), 2 (moderate), 3 (severe) to 4 (very severe)
Higher scores indicate higher activity
PILLThe Pennebaker Inventory of Limbic Languidness (PILL), a self-report questionnaire that assess the frequency of each of the most 54 physical symptoms
The PILL can be scored by summing up the total number of items on which individuals score C, D or E (every month or so or higher)
With this strategy, the mean score is 17.9 (SD = 4.5) based on a sample of 939 college students. You can also simply sum up the 54 items resulting in a mean score of 112.7 (SD = 24.7) (http://homepage.psy.utexas.edu/HomePage/Faculty/Pennebaker/Questionnaires/PILL.pdf)
From 0 to 216:
  • 0 to 21: below normal range
  • 22 to 66: well within normal range
  • 67 to 84: slightly above average, within normal range
  • ≥ 85: top 25%
Higher scores indicate participants are more nervous, distressed and unhappy
POMSThe Profile of Mood States (POMS) (McNair et al.237) consists of 34 items aimed at assessing global negative and positive affect
Participants indicate how often they experienced a particular feeling (e.g. liveliness, forgetfulness, unhappiness) since their cancer diagnosis or their last survey (for subsequent waves)
In the included study by Henry et al.,53 mood disturbance was calculated by summing the negative affect subscales (e.g. anger, depression, tension, fatigue, confusion) and then subtracting the positive affect subscale score (e.g. vigour)
In the included study by Smyth et al.,9 the POMS assessed current mood states using subscales for depression–dejection, tension–anxiety, fatigue–inertia, vigour–activity, anger–hostility and confusion–bewilderment
Scale from 0 (not at all) to 4 (extremely often)Higher scores indicate greater mood disturbance
POMS-nThe negative affect subscale of the Profile of Mood States (POMS; Zevon and Auke238) was measured in Jensen-Johansen et al.76 with a 37-item version validated for use with patients with breast cancer (Di Lorenzo and Williamson239)Scale from 0 (not at all) to 4 (extremely often)Higher scores indicate greater negative affect
POMS-SFThe Short Form of the Profile of Mood States (POMS-SF; Shacham240) is a 37-item questionnaire that comprises six subscales measuring transient states of six moods: tension–anxiety, depression–dejection, anger–hostility, vigour–activity, fatigue–inertia and confusion–bewilderment
Total mood disturbance is assessed as the sum of the scores for these six moods
5-point Likert scale, ranging from 0 (not at all) to 4 (extremely)Higher scores representing greater mood disturbance, except for vigour/activity, where higher scores indicate lesser mood disturbance and the score of this subscale is subtracted from the sum of the rest to provide the total mood disturbance
Poor sleep qualityThe poor sleep quality scale used a 4-item scale designed to evaluate the previous night’s sleep regarding sleep quality, degree to which sleep was restorative, waking daytime level of alertness, and ability to concentrate1–7 scale and averagedHigher values indicate poorer sleep
Post mTBI Symptom ChecklistThe Post Mild Traumatic Brain Injury (mTBI) Symptom Checklist comprised 30 items, describing symptoms that are commonly experienced in the following days or weeks after a mTBI
The list comprises questions about physical changes, changes in thinking, changes in emotions or behaviours
NAThe higher number of items ticked, the greater post-mTBI symptoms
PPMSA Passive Positive Mood Scale (PPMS) was developed for the study by Jensen-Johansen et al.,76 using words reflecting non-active positive mood to supplement the active positive mood items of the POMS vigour subscale
The PPMS consists of items reflecting passive positive mood in the past 7 days (positive/bright, balanced, glad, peaceful, relaxed, at ease, calm, contented)
NAHigher scores indicate better passive positive mood
PSCThe Paediatric Symptom Checklist (PSC) is a 35-item psychosocial screen designed to facilitate the recognition of cognitive, emotional and behavioural problems
The PSC is the parent-completed version, as opposite to the Paediatric Symptom Checklist-Youth Report form (PSC-Y), which is the children-completed version (see p. 317)
Items are rated as never, sometimes or often present and scored 0, 1 and 2, respectively
The total score is calculated by adding together the score for each of the 35 items
A positive score on the PSC indicates need of further evaluation by a qualified health or mental health professional
Both false positive and false negative can occur and this should be interpreted by the appropriate professional
PSC-YThe Paediatric Symptom Checklist-Youth Report form (PSC-Y; Little et al.241) contains 35 items to obtain a child’s report of their emotional and behavioural problems
The items describe specific emotions and behaviours, and the respondent is asked to indicate how often the items apply to them by checking always, sometimes or never
  • For children aged 4 and 5 years, the PSC cut-off score is ≥ 24
  • For children and adolescents aged 6–16 years, a cut-off score of ≥ 28 indicates psychological impairment
  • The cut-off score for the PSC-Y is ≥ 30
Items left blank are ignored. If more than four items are left blank, the questionnaire is considered invalid
A positive score on the PSC-Y indicates need of further evaluation by a qualified health or mental health professional. Both false positive and false negative can occur and this should be interpreted by the appropriate professional
PSQIThe Pittsburgh Sleep Quality Index (PSQI; Buysse et al.242) evaluated habitual sleep disturbances over a 1-month period
It differentiates poor from good sleep quality by measuring seven areas (components): subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleeping medications, and daytime dysfunction over the last month
Responses for each item are: 0 (very good); 1 (fairly good); 2 (fairly bad); 3 (very bad)
The total score sums the seven item scores together
A total score of ≥ 5 is indicative of poor sleep quality
PSSThe 14-item Perceived Stress Scale (PSS) measure was used to assess the degree to which participants found their daily lives over the period of the past 4 weeks to be unpredictable, uncontrollable and overloading
The questionnaire is designed to quantify non-specific appraised stress over the previous month
From 1 (never) to 5 (very often)Higher scores indicate higher levels of appraised stress
PSS-IThe Post-Traumatic Stress Disorder Symptom Scale Interview (PSS-I; Foa et al.243)
The PSS-I was used to generate three PTSD subscale scores for re-experiencing, avoidance, and arousal symptoms
The PSS-I is a 17-item semistructured interview that assesses the presence and severity of DSM-IV PTSD symptoms related to a single identified traumatic event in individuals with a known trauma history. Each item is assessed with a brief, single question. There are no probes or follow-up questions. Interviewees are asked about symptoms they have experienced in the past 2 weeks
For each item, the interviewer assigns a rating to reflect a combination of frequency and severity from 0 (not at all) to 3 (five or more times per week/very much)Higher scores indicate greater symptoms
PTGIThe Post-Traumatic Growth Inventory (PTGI; Tedeschi and Calhoun244) measures the degree of positive changes reported after experiencing a traumatic event
The PTGI measures growth in five domains: new possibilities, relating to others, appreciation of life, personal strength, and spiritual changes
PTGI is a 21-item self-report inventory. In addition to an overall scale score, the PTGI comprises five factors:
  • relating to others
  • new possibilities
  • personal strength
  • spiritual change
  • appreciation for life
6-point Likert type scale, ranging from 0 (I did not experience this change as a result of my crisis) to 5 (a very great degree as a result of my crisis)Higher scores indicate greater positive changes
QEDDThe diagnosis of eating disorder on the Questionnaire for Eating Disorder Diagnosis (QEDD; Mintz et al.245) is a 50-item diagnostic instrument based on DSM-I criteriaNANA
QOLThe Quality of Life Scale (QOL; Burckhardt et al.246), used in Broderick et al.,118 is a 16-item instrument (rather than the 15-item one found in the Flanagan version) designed to measure QoL across a broad array of life domains in patients with chronic illness
Independence, doing for yourself was added after a qualitative study indicated that the instrument had content validity in chronic illness groups but that it needed an item that reflected the importance to these people of remaining independent and able to care for themselves
7-point Likert scale ranging from 1 (terrible) to 7 (delighted)
The instrument is scored by summing the items to make a total score
Higher scores indicate better QoL
RCMASThe Revised Children’s Manifest Anxiety Scale (RCMAS; Reynolds and Richmond247) is subtitled What I Think and Feel, and contains 37 written statements describing feelings or behaviours that the individual is asked to respond to by circling yes or no
This measure assesses the level and nature of children’s anxiety. The yes responses are counted to determine a total anxiety score. There a four subscales (for which scores can be calculated separately): physiological anxiety; worry/oversensitivity; social concerns/concentration; lie
NA
  • High scores on the physiological factor (items 1, 5, 9, 13, 17, 19, 21, 25, 29, 33) can indicate physiological signs of anxiety (e.g. sweaty hands, stomach aches)
  • High scores on the worry/oversensitivity factor (items 2, 6, 7, 10, 14, 18, 22, 26, 30, 34, 37) would suggest that the child internalises their experiences of anxiety and that he/she may feel overwhelmed and withdraw
  • High scores on the concentration anxiety factor (items 3, 11, 15, 23, 27, 31, 35) would suggest that the child is likely to feel that he/she is unable to meet the expectations of other important people, inadequate and unable to concentrate on tasks
RSQThe Recovery Style Questionnaire (RSQ; Drayton et al.248) is a 39-item self-report measure with the categories developed by McGlashan et al.249 integration vs. sealing over styles of adaptation to psychotic illness
The RSQ includes 13 aspects of recovery style, each of which is assessed by three items
Using a formula (Drayton 1998), the scores on each of these aspects are combined into the six following classifications along one dimension:
  • Integration
  • Towards integrating
  • A mixed picture in which integration dominates
  • A mixed picture in which sealing over dominates
  • Towards sealing over
  • Sealing over
  • Scores were summed across the items to provide a total score
Higher scores indicate greater recovery style
Rumination ScaleThe Rumination Scale (McIntosh et al.,250) consists of a 10-item report that assesses people’s tendency to engage in ruminative thinkingNANA
SAMThe paper-and-pencil version of the Self-Assessment Manikin (SAM; Bradley and Lang251) obtains participant’s ratings of valence (pleasantness) and arousal in response to each session (self-reported emotion)9-point Likert-type scale:
  • Valence: from 1 (very pleasant to 9 (very unpleasant)
  • Arousal: from 1 (very calm) to 9 (very aroused)
Higher scores indicate greater pleasantness
SAPASIThe Self-Administered Psoriasis Area and Severity Index (SAPASI; Sampogna et al.252), a patient-rated, psoriasis-specific outcome measure, is a widely validated instrument that provides an objective measure of disease severity, and has been effectively used in previous studies
Participants rate the colour, induration, and scaliness of an average psoriatic lesion using three modified VASs. As in the original PASI, the SAPASI weights the involvement of the head (H), upper extremities (U), trunk (T) and legs (L) as 10%, 20%, 30%, and 40% of the total body area, respectively
SAPASI = (0,1 × AH) + (0,2 × AU) + (0,3 × AT) + (0,4 × AL)Higher scores indicate greater severity 
SCL-90-RThe Symptom Checklist-90-Revised (SCL-90-R) is a 90-item, self-report measure of current psychological symptomatology, including global psychological distress
It is a multidimensional complaint list based on a self-assessment covering an important part of the compliant that can be seen in the psychiatric inpatient clinic
5-point Likert scale ranging from 0 (not at all) to 4 (extremely)
Items are summed for a total score
Higher scores indicate greater distress and psychological symptoms
SCSThe Social Constraints Scale (SCS; Lepore and Ituarte253) is a 15-item scale assessing perceived inadequacy of social support resulting in reluctance among individuals to express thoughts and feelings about a specific stressor, in this case their cancer experience
Example items include: How often did they avoid you? How often did they minimise your problems? How often did they tell you to try not to think about your cancer? and How often did they make you feel as though you had to keep feelings about your cancer to yourself, because they made him/her feel uncomfortable?
In Zakowski et al.,84 two forms of the SCS were used: one asking about constraints from patient’s spouse or partner and one asking about constraints from people in their lives other than their spouse or partner (e.g. friends or family members)
The mean of the two constraint scores in all analyses (among the 19 patients who had no current spouse or partner, the constraints from others score was used, in that we considered this score to be reflective of their average constraint level) were used in the aforementioned study
Scores range from 15 (low constraints) to 60 (high constraints)Higher scores indicate higher social constraints
SDSCASummary of Diabetes Self-Care Activities scale (revised) (SDSCA; Toobert et al.254)
Splits into general diet, specific diet, exercise, blood glucose testing and foot care subscales
NANA
Self-rated health status (a)Compared with the person in excellent health, how would you rate your health at the present time?7-point scale from 1 (terrible) to 7 (excellent)Higher scores indicate better health
Self-rated health status (b)How you rate your health overall?From 1 (very bad) to 5 (very good)Higher scores indicate better health
Serum cytokine levels of TNF-α, IL-4 and IL-10Levels were determined using a high sensitivity ELISA sandwich essay
In this method, the concentration of the selected cytokine in the serum is calculated from the linear portion of a standard curve of purified cytokine at known concentrations
The detection limits of the assay were < 0.25 pg/mlThe detectable range for TNF-α was 0.5–32 pg/ml and for IL-10 0.8–50 pg/ml
Sexual health and performanceIn the included study by Pauley et al.,82 sexual health and performance was assessed by a designed 6-item measure created by the authors
The scale was intended to work as two separate subscales: one measuring performance and the other measuring sexual desire
NAHigher scores indicate greater levels
SF-12The Short Form questionnaire-12 items (SF-12; Ware et al.255) is a widely used, brief generic measure of self-reported health status derived from the larger SF-36 survey
Self-ratings are made of severity and frequency of 12 physical and mental health problems, as well as of their impact on the patient’s overall perceived health status
This modified version of the SF-36 has consistently been shown to have good reliability and validity
It yields both physical health and mental health summary scores, which are reported as standard scoresSlower scores indicated positive psychological and physical health
SF-36The Medical Outcomes Short Form questionnaire-36 items (SF-36; Ware and Sherbourne256) is used to evaluate psychological (SF mental), physical health (SF physical) and general health
The eight subscales include (a) limitations in physical activities because of health problems; (b) limitations in social activities because of physical or emotional problems; (c) limitations in usual role activities because of physical health problems; (d) bodily pain; (e) general mental health (psychological distress and well-being); (f) limitations in usual role activities because of emotional problems; (g) vitality (energy and fatigue); and (h) general health perceptions
A physical health composite score embodies concepts (a), (c), (e) and (g) and a mental health composite score embodies concepts (b), (d), (e) and (f)
This instrument has been also used a measure of HRQoL
In the included study by Broderick et al.,118 four additional subscales from the MOS-SF-36 General Health Survey were selected: overall health, social functioning, health distress, and cognitive dysfunction. Three additional items assessing tiredness on awakening, tiredness during the day, and quality of sleep were rated over the past week on 4-point scales
6-point Likert scale from 1 (excellent) to 5 (worst)Lower scores indicated positive psychological and physical health
SF-36v2 Health SurveyThe SF-36v2 Health Survey (Ware257) is a 36-item inventory that yields eight scale scores and two summary scores for physical and mental health
The 1998 US norm-based scoring in version 2 allows for ready interpretation of scores relative to general population norms
The eight scaled scores are the weighted sums of the questions in their section. Each scale is directly transformed into a 0–100 scale. The eight sections are vitality, physical functioning, bodily pain, general health perceptions, physical role functioning, emotional role functioning, social role functioning and mental health
In the included study by Broderick et al.,118 the Pain Catastrophising Scale served as a primary outcome, because it measures the physical health status of the patient. The Mental Component Summary (MCS) was also examined to determine whether a psychological impact of the intervention was observed
Total score in each component ranges from 0 to 100The higher the score the less disability
SGRQThe St George’s Respiratory Questionnaire (SGRQ) is a disease-specific instrument designed to measure impact on overall health, daily life and perceived well-being, to be used in patients with fixed and reversible airway obstruction
It has 76 questions in three sections: symptoms (frequency and severity), activity (activities that cause or are limited by breathlessness) and impacts (social functioning and psychological disturbances resulting from airways disease)
Total score ranges from 0 to 100Higher scores indicate poor health
SIPThe Sickness Impact Profile (SIP; de Bruin et al.258) used in the included study by Hughes54 is 136 items
The SIP contains three items: the physical functioning scale, mobility subscale (SIP-m), and the recreation and pastimes subscale (SIP-r&p-t)
The SIP describes activities of daily living divided in 12 categories
Numerical scaleHigher scores indicate greater dysfunction
Skindex-29The Skindex-29 (Chren et al.259) has been shown to be a valuable tool for measuring HRQoL (QoL) in dermatological patients, as reported in the included study by Paradisi et al.110
Its Italian version was developed following guidelines for the cross-cultural adaptation of HRQoL measures and validated in a previous survey260
VAS scale from 0 (no pain) to 10 (worst possible)Higher scores indicate poorer QoL
SOCThe Sense of Coherence Scale (SOC) is a 13-item self-report instrument (Antonovsky261) based on the following underlying constructs: comprehensibility, manageability and meaningfulness
The SOC items are scored along the 7-point scale
7-point scale with two anchoring phrases: ‘until now life has had no clear goals or purpose at all’ and ‘until now life has had very clear goals and purpose’Higher scores indicate a strong sense of coherence
Social Constraints ScaleThe Social Constraints Scale (Lepore et al.262) is a 15-item scale assessing perceived inadequacy of social support resulting in reluctance to express thoughts and feelings about a specific stressor, in this case, experience with amyotrophic lateral sclerosis (e.g. How often did they tell you not to think about amyotrophic lateral sclerosis?)
All items referred to respondent’s experiences over the prior week
5-point scale ranging from 1 (almost never) to 5 (almost always)Higher scores indicate greater social constraint
Somatisation ScaleThe Somatisation Scale (13 items) includes 13 common physical complaints (e.g. stomach pain, back pain, headaches), from which a severity score can be calculatedRange 0–4NR
SOPAThe control subscale of the Survey of Pain Attitudes (SOPA; Jensen et al.263) is a questionnaire to measure feelings of personal control over pain
The SOPA is the most widely used measure of pain-related attitudes (De Good and Tait;264 Jensen et al.263)
5-point scale from 0 (this is very untrue for me) to 4 (this is very true for me)
After reversing responses on the four absence of control items, responses are summed to create a total score
Higher scores indicate greater control over pain
SOSThe Significant Others Scale (SOS) measured how much practical and emotional support that individual provided responding to two questions for each item:
Emotional support answered by:
  • (1) Can you trust, talk frankly and share your feelings with this person?
  • (2) Can you lean on and turn to this person in times of difficulty?
Practical support:
  • (1) Does he/she give you practical help?
  • (2) Can you spend time with this person socially? Responses were rated on
From 1 (never) to 7 (always) scaleHigher scores indicate greater emotional support
SSQ AsthmaThe Wasserfallen Symptom Score Questionnaire (SSQ): asthma subscaleNANA
SSQ AwakeningsThe Wasserfallen Symptom Score Questionnaire (SSQ): awakenings subscaleNANA
STAI-SThe State/Trait Anxiety Scale (STAI-S) is a 20-item, self-report instrument that assesses the subjective feelings of apprehension, nervousness and anxiety at the moment4-point Likert scale ranging from not at all, somewhat, moderately so, to very much soHigher scores indicate greater state anxiety
Stigma ScaleThe Stigma Scale, designed for individuals diagnosed with HIV/AIDS, consisted of 13 items that evaluated fear, avoidance, and perceived negative responses related to HIV status1–4 ordinal scale reported as strongly, not at all, rarely, sometimes, often
Total scores ranging from a low of 13 to a high of 52
Higher scores equating to greater stigma
Survey–18 physical symptoms itemsThe Survey–18 physical symptoms items includes items derived from other reports for their appropriateness for the sample in the included study by Henry et al.53 (Anderson and Tewfik;265 Ganz and Coscarelli;266 Whelan et al.267)
Example symptoms included fatigue, nausea, appetite loss, breast pain, hair loss, weight gain, hot flashes, itchiness or discomfort of the skin, decreased arm mobility and swelling of the arm
A 7-point scale was used, ranging from 1 (not at all) to 7 (severe)Higher scores indicate greater physical symptoms
SUSThe Social Undermining Scale (SUS; Vinokur and van Ryn268) assesses the extent to which each of the four most important people in participant’s lives caused them distress by acting in an unpleasant or angry manner towards them, criticising them or making their life difficult5-point scale
Swollen joint countJoint swelling reflects local inflammation and limited motion in affected areas. The patient’s rheumatologist, blind to the patient’s experimental condition, evaluated 16 joints bilaterally (five interphalangeal and five metacarpal phalangeal joints in addition to shoulder, elbow, wrist, knee ankle and metatarsals, for a total of 32 joints) and the presence or absence of swelling was recorded for each joint
Symptom and Emotion Self-report SurveyParticipants rated the degree to which they were currently experiencing physical symptoms and emotions. The symptom items were averaged to yield a symptom score, and emotion items were averaged to form positive and negative emotion scores5-point scale from 1 (not at all) to 5 (a great deal) and scored
Symptom Checklist-90-RevisedPhysical symptoms are reported on a 12-item somatisation subscale of the Symptom Checklist-90-Revised (SCL-90-R)
In the included study by D’Souza et al.101 symptoms were rated regarding the past month, and ratings were totalled
Rated from 0 (not at all) to 4 (extremely)
SLESQThe Stressful Life Events Screening Questionnaire (SLESQ) (10 items) includes 10 psychosocial complaints common among health-care seeking populations (e.g. difficulties with family support, problems with significant others, and financial concerns)Range 1–4NR
The Ways of Coping-Cancer VersionThe Ways of Coping-Cancer Version is a self-report checklist of coping responses to cancer-related stressors
It assesses the frequency of problem-focused and emotion-focused coping efforts
TLEQThe Trauma Life Experience Questionnaire (TLEQ; Kubany et al.269) is a 23-item self-report measure of 22 types of potentially traumatic events including natural disasters, exposure to warfare, robbery involving a weapon, physical abuse and being stalked
TLEQ measures type and frequency of trauma event exposures, and responses to these exposures
The TLEQ has strong psychometric properties (Kubany et al.269) and was completed at the baseline assessment
Trauma exposure was scored only if the person indicated exposure to the traumatic event and a response to the event that was consistent with DSM-IV PTSD criterion A2
For each event, respondents are asked to provide the number of times it occurred, ranging from never to more than five times, and whether fear, helplessness or horror was present: yes/noHigher scores indicate greater trauma
TLFB abstinenceTimeline Followback Method (TLFB) of assessing number of abstinent daysLarger number means longer abstinence
UCLA-CharlesThe UCLA-Charles R Drew University Women and Family Project (Wyatt and Chin270) was adapted to assess changes in meaning and perceived benefits
Participants were asked how, if at all, being HIV positive changed the way they think about themselves, changed them as a person, changed the way they are with other people, and changed their priorities
Different categories were developed, based on the literature and on an initial analysis of 14 patients
Ten categories of positive changes, six categories of negative changes and three categories of mixed or neutral changes, as well as codes for uncategorised positive and negative changes
The number of changes falling into the positive categories and negative categories was computed for each participant
Higher scores indicate greater changes?
VSQ-9The Visit Specific Satisfaction Questionnaire (VSQ; Ware and Hays271), a self-report measure administered to participants and providers at the conclusion of the 3-month follow-up periodTo score the VSQ-9, the responses from each individual should be transformed linearly to a 0–100 scale, with 100 corresponding to excellent and 0 corresponding to poor
Responses to the nine VSQ items should then be averaged together to create a VSQ-9 score for each person
Higher scores indicate greater satisfaction related to the visits
Walking speed and grip strengthIn the included study by Lumley et al.,115 patients were instructed to walk as quickly as possible, but safely down a 50-foot corridor, and recorded the time to do so in seconds
In addition, patient’s grip strength was assessed by having them squeeze, as firmly as possible, a sphygmomanometer bulb, and the pressure generated was recorded from two trials with each hand; all four values were averaged to a single score
NAWalking speed: higher values mean slower walking
Grip strength: higher values indicate better functioning
Well-beingIn the included study by Cepeda et al.85 each patient’s sense of general well-being was rated7-point Likert scale from awful to excellentHigher scores indicate better well-being 
WHYMPI –pain subscaleThe Pain Severity subscale of the West Haven-Yale Multidimensional Pain Inventory (WHYMPI; Kerns et al.272) is a 61-item self-report inventory across three domains
The WHYMPI is for use in chronic pain populations. It generates 13 empirically derived scale scores, including pain severity, perception of how pain interferes with daily life activities, appraisals of the support received from significant others, and perception of how significant others respond to their displays of pain
From 0 to 6Higher scores indicate more extreme pain

AIDS, acquired immunodeficiency syndrome; CD3+, Cluster of differentiation antigen 3-positive lymphocyte; ELISA, enzyme-linked immunosorbent assay; FIQ, Fibromyalgia Impact Questionnaire; HAQ, Health Assessment Questionnaire; IL-4, interleukin 4; IL-10, interleukin 10; NA, not available; NR, not reported; PCR, polymerase chain reaction; RAI, Rheumatology Attitudes Index; RNA, ribonucleic acid; VAS, visual analogue scale.

Quality assessment

TABLE 107

Quality of the included studies

First author, yearRandomisationBlinding
Sequence generation? (Selection bias)Method description given?Allocation concealment? (Selection bias)OutcomePerformanceITT analysis?Selective reporting? (Description of outcomes differences between groups)Attrition bias? (Description of withdrawals)Pre-specified criteria for eligibility of patients?Similarity of groups at baseline regarding prognostic factors?
Abel 200450YNUUUYNUUY
Arden-Close 201380YYYUNYNNYN
Averill 2013100YYUUYNYYYN
Bartasiuniene 2011102YNUUNYNNUY
Bernard 200693YYYUUNNNYN
Broderick 2004113YNYUNYYYYY
Broderick 2005118YYYUNNUYYY
Canna 200694YNYNYNNUYY
Cepeda 200885YNYYUYYYYY
Craft 201374YYUUUNNYYY
Dennick 201488YYYYYYNNYY
D’Souza 2008101YYYNYYNNNY
Gellaitry 201075YYUUUNYNYY
Gidron 199698YNUNYYUYUN
Gillis 2006119YYYUYYYYYN
Golkaramnay 200768NANANANANANANANANANA
Graf 200895YYNUNYNNYN
Graham 200851YYYYUNYYYY
Grasing 201090NNNUUUYYYN
Halpert 201052NYNUNNNYYN
Hamilton-West 2007114YYYYNYYYYU
Harris 2005106YYYNNNNYNN
Henry 201053NANANANANANANANANANA
Hevey 2012103YNUUUNYNUU
Hong 201167YYNUUYUUYN
Hughes 200754YUNNNYNYYY
Ironson 201371YNUUUUNUYN
Jensen-Johansen 201376YYYUYNNU
Kraaij 201055YNUUUNYYUN
Krpan 201396YUUUUUNUUU
Lange 200369YNUUYNYYNY
Lumley 2011115YNUUUYYYNY
Lumley 2014116YNNUUYYYNY
Mann 200172YNUUUNNYNN
McElligott 200687YUNNUYNUYY
Meshberg-Cohen 201091YUUUUYYNYY
Milbury 201481YYUUUNNYYY
Mosher 201277YYUUUYUYYY
Pauley 201182YYUUUNYNYU
Paradisi 2010110YYUUNNYYYY
Park 201278NUUUUYUUYN
Petrie 200456YYYUUUNUYY
Richards 200097YNUUUNUYYY
Rickett 201166YNUUUNNYNU
Rini 201486YYYYYYUUYY
Robinson 200899YYNUYYNNYN
Rosenberg 200283YNYUUUYUYN
Sharifabad 2010105YNUUUYNUYN
Sloan 201270YYYUUUNYYY
Smyth 1999107YYYNUNNYYY
Smyth 2008121YNUUUUYYNU
Stark 201057YYUUUNUYYY
Tabolli 2012111YYYUUNNYYN
Taylor 200389YNUUUYNNNN
Theadom 201058YNUUUNNYY
Van Dam 201392YYYUUNNUUY
Vedhara 2007112YYUUUYNYNY
Wagner 201073YYUYYNYYYU
Walker 199979YNUYYNNYYN
Wallander 2011109YYNNUNNYNY
Warner 2006108YYUNNNUYYY
Wetherell 2005117YNUYUNYYYY
Willmott 2011104YYYUYNYNYN
Zakowski 200484YNUUUYYUNY

N, no; NA, not applicable; U, unclear meaning not reported; Y, yes.

TABLE 108

Quality assessment summary

Number of studiesQuality assessment items
53Studies were truly randomised (a valid method of randomisation was reported)
24Studies were reported as randomised but the method of randomisation was not given
18Studies were reported as having concealed the allocation of the sequence randomisation
6Studies preserved blinding for outcome assessment
11Studies preserved blinding during performance
25Studies analysed the outcomes using the ITT approach
44Studies reported outcomes differences between groups
44Studies provided a description of withdrawals
44Studies reported the prespecified criteria for eligibility of patients
33Studies reported assessing similar groups at baseline
Copyright © Queen’s Printer and Controller of HMSO 2016. This work was produced by Nyssen et al. under the terms of a commissioning contract issued by the Secretary of State for Health. This issue may be freely reproduced for the purposes of private research and study and extracts (or indeed, the full report) may be included in professional journals provided that suitable acknowledgement is made and the reproduction is not associated with any form of advertising. Applications for commercial reproduction should be addressed to: NIHR Journals Library, National Institute for Health Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK.

Included under terms of UK Non-commercial Government License.

Bookshelf ID: NBK355717

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