Supplementary Online Content Puetz TW, Morley CA, Herring MP. Effects of creative arts therapies on psychological symptoms and quality of life in patients with cancer. JAMA Intern Med. Published online May 13, 2013. doi:10.1001/jamainternmed.2013.836. ereferences. Bibliography of included trials etable 1. Definitions for levels of moderators etable 2. Statistical tests of publication bias etable 3. Summary of anxiety univariate moderator analysis etable 4. Summary of depression univariate moderator analysis etable 5. Summary of fatigue univariate moderator analysis etable 6. Summary of pain univariate moderator analysis etable 7. Summary of QOL univariate moderator analysis efigure. Funnel plots This supplementary material has been provided by the authors to give readers additional information about their work.
ereferences. Bibliography of Included Trials 1. Bruera E, Willey J, Cohen M, Palmer JL. Expressive writing in patients receiving palliative care: a feasibility study. J Palliat Med. 2008;11(1):15-19. 2. Bulfone T, Quattrin R, Zanotti R, Regattin L, Brusaferro S. Effectiveness of music therapy for anxiety reduction in women with breast cancer in chemotherapy treatment. Holist Nurs Pract. 2009;23(4):238-242. 3. Burns SJ, Harbuz MS, Hucklebridge F, Bunt L. A pilot study in to the therapeutic effects of music therapy at a cancer help center. Altern Ther Health Med. 2001;7(1):48-56. 4. Cassileth BR, Vickers AJ, Magill LA. Music therapy for mood disturbance during hospitalization for autologous stem cell transplantation: a randomized controlled trial. Cancer. 2003;98(12):2723-2729. 5. Clark M, Isaacks-Downton G, Wells N, et al. Use of preferred music to reduce emotional distress and symptom activity during radiation therapy. J Music Ther. 2006;43(3):247-265. 6. de Moor C, Sterner J, Hall M, et al. A pilot study of the effects of expressive writing on psychological and behavioral adjustment in patients enrolled in a phase II trial of vaccine therapy for metastatic renal cell carcinoma. Health Psychol. 2002;21(6):615-619. 7. Dibbell-Hope S. The use of dance/movement therapy in psychological adaptation to breast cancer. Arts Psychother. 2000;27(1):51-68. 8. Ferrer AJ. The effect of live music on decreasing anxiety in patients undergoing chemotherapy treatment. J Music Ther. 2007;44(3):242-255. 9. Gellaitry G, Peters K, Bloomfield D, Home R. Narrowing the gap: the effects of an expressive writing intervention on perceptions of actual and ideal emotional support in women who have completed treatment for early stage breast cancer. Psychooncology. 2010;19(1):77-84. 10. Hanser SB, Bauer-Wu S, Kubicek L, et al. Effects of a music therapy intervention on quality of life and distress in women with metastatic breast cancer. J Soc Integr Oncol. 2006;4(3):116-124. 11. Hilliard RE. The effects of music therapy on the quality and length of life of people diagnosed with terminal cancer. J Music Ther. 2003;40(2):113-137. 12. Huang S, Good M, Zauszniewski JA. The effectiveness of music in relieving pain in cancer patients: a randomized controlled trial. Int J Nurs Stud. 2010;47(11):1354-1362. 13. Kwekkeboom KL. Music versus distraction for procedural pain and anxiety in patients with cancer. Oncol Nurs Forum. 2003;30(3):433-440. 14. Li XM, Yan H, Zhou KN, Dang SN, Wang DL, Zhang YP. Effects of music therapy on pain among female breast cancer patients after radical mastectomy: results from a randomized controlled trial. Breast Cancer Res Treat. 2011;128(2):411-419.
15. Lin MF, Hsieh YJ, Hsu YY, Fetzer S, Hsu MC. A randomized controlled trial of the effect of music therapy and verbal relaxation on chemotherapy-induced anxiety. J Clin Nurs. 2011;20(7-8):988-999. 16. Monti DA, Peterson C, Kunkel EJS, et al. A randomized, controlled trial of mindfulness-based art therapy (MBAT) for women with cancer. Psychooncology. 2006;15(5):363-373. 17. Nguyen TN, Nilsson S, Hellstrom AL, Bengtson A. Music therapy to reduce pain and anxiety in children with cancer undergoing lumbar puncture: a randomized clinical trial. J Pediatr Oncol Nurs. 2010;27(3):146-155. 18. Puig A, Lee SM, Goodwin L, Sherrard PAD. The efficacy of creative arts therapies to enhance emotional expression, spirituality, and psychological well-being of newly diagnosed stage I and stage II breast cancer patients: a preliminary study. Arts Psychother. 2006;33(3):218-228. 19. Rosenberg HJ, Rosenberg SD, Ernstoff MS, et al. Expressive disclosure and health outcomes in a prostate cancer population. Int J Psychiatry Med. 2002;32(1):37-53. 20. Sabo CE, Michael SR. The influence of personal message with music on anxiety and side effects associated with chemotherapy. Cancer Nurs. 1996;19(4):283-289. 21. Sandel SL, Judge JO, Landry N, Faria L, Ouellette R, Majczak M. Dance and movement program improves quality of life measures in breast cancer survivors. Cancer Nurs. 2005;28(4):301-309. 22. Shabanloei R, Golchin M, Esfahani A, Dolatkhah R, Rasoulian M. Effects of music therapy on pain and anxiety in patients undergoing bone marrow biopsy and aspiration. AORN J. 2010;91(6):746-751. 23. Smith M, Casey L, Johnson D, Gwede C, Riggin OZ. Music as a therapeutic intervention for anxiety in patients receiving radiation therapy. Oncol Nurs Forum. 2001;28(5):855-862. 24. Stordahl JJ. The influence of music on depression, affect, and benefit finding among women at the completion of treatment for breast cancer [dissertation]. Coral Gables, Florida: University of Miami; 2009. 25. Svensk AC, Oster I, Thyme KE, et al. Art therapy improves experienced quality of life among women undergoing treatment for breast cancer: a randomized controlled study. Eur J Cancer Care. 2009;18(1):69-77. 26. Thyme KE, Sundin EC, Wiberg B, Oster I, Astrom S, Lindh J. Individual brief art therapy can be helpful for women with breast cancer: a randomized controlled clinical study. Palliat Support Care. 2009;7(1):87-95. 27. Zimmerman L, Pozehl B, Duncan K, Schmitz R. Effects of music in patients who had chronic cancer pain. West J Nurs Res. 1989;11(3):298-309.
etable 1. Definitions for levels of moderators Effect Moderator Levels Participant Characteristics Nationality Sex Age Baseline symptom score United States: data from participants from the United States only Other: data from participants from countries other than the United States Male: data from male patients only Female: data from female patients only Mixed: data from samples that combined male and female patients Continuous variable: years Continuous variable: T scores Intervention Characteristics Intervention mode Therapeutic monitoring Intervention type Session type Session duration Program duration Art: the intervention used a 2-dimensional (eg, drawing) and/or 3-dimensional (eg, sculpting) modality Dance: the intervention used a dance or movement modality Music: the intervention used a music-listening and/or participation modality Writing: the intervention used an expressive writing modality Creative arts therapist: the intervention sessions were directly led and monitored by a therapist No creative arts therapist: the intervention was developed by a therapist, but sessions were not directly led or monitored by a therapist Individual: the intervention was conducted one on one between the patient and a therapist Group: the intervention was conducted with 2 or more patients and a therapist Single session: the intervention consisted of a single CAT session Multisession: the intervention consisted of two or more CAT sessions Continuous variable: minutes Continuous variable: weeks
Study Design Characteristics Intervention period Intervention setting Intervention confound Homogeneity of cancer group Type of comparison During treatment: the intervention included individuals diagnosed with cancer currently undergoing active treatment (eg, chemotherapy) Posttreatment: the intervention included individuals diagnosed with cancer following the completion of active treatment (eg, chemotherapy) Inpatient: the intervention included any health care service setting in which the patient is admitted to a facility (eg, hospital, nursing home) Outpatient: the intervention included any health care service setting in which the patient is not admitted to a facility (eg, physician's office, clinic, patient s home) Other: the intervention used a setting not categorized above (eg, community center) Confounded: the intervention consisted of both CAT treatment and 1 or more additional intervention components (eg, education, counseling, pharmacotherapy) Not confounded: the intervention consisted of only CAT treatment without the addition of other intervention components (eg, education, counseling, pharmacotherapy) Homogeneous: the study included only a defined sample of cancer patients (eg, breast cancer) Heterogeneous: the study included a mixed sample of cancer patients (eg, breast, prostate, and lung cancer) No treatment: the study used a no-treatment control comparison condition Waitlist: the study used a waiting-list control comparison condition Usual care: the study used a usual-care control comparison condition Placebo: the study used a placebo control comparison condition
Outcome Measure Anxiety STAI: study used the State-Trait Anxiety Inventory POMS Tension: study used the Profile of Mood States Tension Scale SCL-90 Anxiety: study used the Symptom Checklist-90 Anxiety Scale HADS Anxiety: study used the Hospital Anxiety Depression Scale VAS Anxiety: study used a visual analog scale for anxiety Depression POMS Depression: study used the Profile of Mood States Depression Scale SCL-90 Depression: study used the Symptom Checklist- 90 Depression Scale HADS Depression: study used the Hospital Anxiety Depression Scale CES-D: study used the Center for Epidemiologic Studies Depression Scale Pain VAS Pain: study used a visual analog scale for pain MPQ: study used the McGill Pain Questionnaire Other: study used a pain measure not categorized above Fatigue POMS Fatigue: study used the Profile of Mood States Fatigue Scale VAS Fatigue: study used a visual analog scale for fatigue Quality of Life FACT: study used the Functional Assessment of Cancer Therapy scale Other: study used a fatigue measure not categorized above Abbreviation: CAT, creative arts therapies.
etable 2. Statistical tests for publication bias Begg Rank Correlation Model Kendall s τ df P Value Anxiety -0.05 24.738 Depression -0.23 10.342 Pain -0.06 17.755 Fatigue -0.27 6.427 Quality of Life -0.41 5.251 Egger Regression Test Model β t Test df P Value Anxiety -2.33-1.29 23.212 Depression -0.39-0.27 9.795 Pain -1.56-0.92 16.369 Fatigue -0.64-0.32 5.762 Quality of Life -2.38-1.31 4.260
etable 3. Summary of anxiety univariate moderator analysis Effect Moderator Effects (k) Δ or β 95% CI P Value I 2 Demographics Nationality United States 17-0.2229 0.03 to 0.42.0007 14.8% Other 8-0.3799 0.11 to 0.65.0065 4.9% Sex Male 3-0.2160-0.27 to 0.70.3857 0.0% Female 7-0.4200-0.11 to 0.72.0075 10.3% Mixed 15-0.2238-0.02 to 0.43.0316 26.2% Age (years) 25-0.0038-0.02 to 0.01.6367 8.5% Baseline score (T score) 24-0.0069-0.01 to 0.03.5267 6.3% Intervention Characteristics Intervention mode Art 3-0.3990-0.05 to 0.84.0828 0.0% Dance 2-0.4579-0.18 to 1.09.1575 NA Music 18-0.2736-0.09 to 0.45.0033 27.4% Writing 2-0.1106-0.75 to 0.52.7328 NA Therapeutic monitoring Creative arts therapist 7 0.1698-0.12 to 0.46.2511 44.9% No creative arts therapists 18 0.3223-0.13 to 0.51.0009 0.0% Intervention type Individual 22 0.2606-0.09 to 0.43.0030 15.6% Group 3 0.3937-0.82 to 0.86.1047 0.0% Session type Single session 10-0.3261-0.08 to 0.58.0105 20.4% Multisession 15-0.2403-0.03 to 0.45.0258 6.6% Session duration (minutes) 21-0.0001-0.01 to 0.00.9495 6.4% Program duration (weeks) 25-0.0244-0.07 to 0.02.2682 9.2% Study Characteristics Intervention period During treatment 22 0.2305 0.07 to 0.39.0053 14.2% Posttreatment 3 0.6519 0.20 to 1.11.0051 0.0% Intervention setting Inpatient 2-0.4246-0.18 to 1.03.1684 NA Outpatient 21-0.2514-0.08 to 0.42.0041 8.6% Other 2-0.4579-0.18 to 1.10.1607 NA
Intervention confound Confounded 16 0.2984-0.09 to 0.51.0051 1.1% Not confounded 9 0.2428-0.01 to 0.50.0623 29.0% Homogeneity of group - Homogeneous 10 0.4538-0.21 to 0.70.0004 16.0% Heterogeneous 15 0.1674 0.03 to 0.36.0949 6.5% Type of comparison No treatment 0 NA NA NA NA Waiting list 4-0.4686-0.08 to 0.86.0177 0.0% Usual care 15-0.3460-0.16 to 0.53.0003 40.3% Placebo 6-0.0408-0.36 to 0.27.8009 0.0% Outcome measure STAI 12-0.3265-0.13 to 0.52.0010 44.7% POMS Tension 4-0.5550-0.20 to 0.91.0023 37.9% SCL-90 Anxiety 3-0.3036-0.08 to 0.68.1163 0.0% HADS Anxiety 3-0.2676-0.62 to 0.09.1446 0.0% VAS Anxiety 3-0.3906-0.02 to 0.75.0373 58.9% Abbreviations: HADS, Hospital Anxiety Depression Checklist; NA, not applicable; POMS, Profile of Mood States; SCL-90, Symptom Checklist-90; STAI, State-Trait Anxiety Inventory; VAS, visual analog scale.
etable 4. Summary of depression univariate moderator analysis Effect Moderator Effects (k) Δ or β 95% CI P Value I 2 Demographics Nationality United States 10-0.2244-0.05 to 0.39.0097 30.2% Other 1-0.2115-0.40 to 0.83.4996 NA Sex Male 0 -NA NA NA NA Female 7-0.3029-0.09 to 0.52.0054 41.9% Mixed 4-0.1089-0.15 to 0.37.4049 0.0% Age (years) 11-0.0070-0.06 to 0.05.8112 21.5% Baseline score (T score) 10-0.0036-0.02 to 0.02.7350 19.2% Intervention Characteristics Intervention mode Art 3-0.4157-0.13 to 0.70.0047 70.0% Dance 2-0.5442-0.05 to 1.04.0306 NA Music 5-0.0807-0.15 to 0.31.4979 0.0% Writing 1-0.1480-0.75 to 0.46.6320 NA Therapeutic monitoring Creative arts therapist 8 0.2135-0.03 to 0.39.0210 28.4% No creative arts therapists 3 0.2681-0.11 to 0.65.1695 66.9% Intervention type Individual 8 0.1479-0.05 to 0.34.1394 33.6% Group 3 0.3984-0.10 to 0.70.0088 0.0% Session type Single session 0 -NA -NA NA NA Multisession 11-0.2300-0.05 to 0.40.0130 21.5% Session duration (minutes) 10-0.0026-0.01 to 0.01.0810 30.2% Program duration (weeks) 11-0.0273-0.07 to 0.02.2494 21.5% Study Characteristics Intervention period During treatment 9 0.1837 0.07 to 0.39.0053 27.3% Posttreatment 2 0.5442 0.20 to 1.11.0051 NA Intervention setting Inpatient 1-0.1897-0.28 to 0.66.4322 NA Outpatient 8-0.1828-0.01 to 0.37.0550 37.7% Other 2-0.5442-0.05 to 1.04.0306 NA
Intervention confound Confounded 6 0.1445-0.09 to 0.38.2233 16.2% Not confounded 5 0.3014-0.07 to 0.53.0105 48.4% Homogeneity of group - Homogeneous 8 0.2205-0.01 to 0.43.0423 42.2% Heterogeneous 3 0.2278-0.03 to 0.48.0818 7.3% Type of Comparison No treatment 0 NA NA NA NA Waiting list 4-0.4949-0.22 to 0.77.0004 31.7% Usual care 5-0.1043-0.12 to 0.33.3642 0.0% Placebo 2-0.1034-0.60 to 0.39.6842 NA Outcome measure POMS Depression 4-0.3239-0.03 to 0.62.0312 69.8% SCL-90 Depression 3-0.3346-0.04 to 0.63.0240 0.0% HADS Depression 3-0.0515-0.23 to 0.33.7203 35.1% CES-D 1-0.0100-0.88 to 0.87.9822 NA Abbreviations: CES-D, CES-D Center for Epidemiological Studies Depression; HADS, Hospital Anxiety Depression Scale; NA, not applicable; POMS, Profile of Mood States; SCL-90, Symptom Checklist-90.
etable 5. Summary of Fatigue Univariate Moderator Analysis Effect Moderator Effects (k) Δ or β 95% CI P Value I 2 Demographics Nationality United States 7-0.1637-0.04 to 0.37.1232 0.0% Other 0 -NA NA NA NA Sex Male 0 -NA NA NA NA Female 2-0.3529-0.11 to 0.82.1232 NA Mixed 5-0.1168-0.12 to 0.35.3247 0.0% Age (years) 7-0.0405-0.12 to 0.04.3125 0.0% Baseline score (T score) 6-0.0080-0.06 to 0.04.7406 0.0% Intervention Characteristics Intervention mode Art 1 0.2196-0.41 to 0.85.4942 NA Dance 1 0.5160-0.18 to 1.21.1465 NA Music 4 0.1335-0.12 to 0.39.2987 0.0% Writing 1 0.0203-0.58 to 0.62.9476 NA Therapeutic monitoring Creative arts therapist 4 0.1683-0.09 to 0.42.2009 0.0% No creative arts therapists 3 0.1551-0.20 to 0.51.3885 28.0% Intervention type Individual 6 0.1291-0.09 to 0.34.2458 0.0% Group 1 0.1560-0.18 to 1.21.1465 NA Session type Single session 1 0.0396-0.51 to 0.59.8887 NA Multisession 6 0.1840-0.04 to 0.41.1082 0.0% Session duration (minutes) 7 0.0024-0.01 to 0.01.3167 0.0% Program duration (weeks) 7 0.0215-0.09 to 0.14.2392 0.0% Study Characteristics Intervention period During treatment 6 0.1291-0.09 to 0.35.2458 0.0% Posttreatment 1 0.5160-0.18 to 1.21.1265 NA Intervention setting Inpatient 1 0.3286-0.15 to 0.80.1756 NA Outpatient 5 0.0760-0.17 to 0.32.5439 0.0% Other 1 0.5160-0.18 to 1.21.1465 NA Intervention confound Confounded 4 0.2166-0.07 to 0.50.1338 0.0%
Not confounded 3 0.1015-0.21 to 0.40.5169 0.0% Homogeneity of group - Homogeneous 4 0.2663-0.03 to 0.55.0737 0.0% Heterogeneous 3 0.0575-0.24 to 0.35.7042 0.0% Type of comparison No treatment 0 NA NA NA NA Waiting list 2 0.3529-0.11 to 0.82.1386 NA Usual care 4 0.1335-0.11 to 0.38.2987 0.0% Placebo 1 0.0203-0.58 to 0.62.9476 NA Outcome measure POMS Fatigue 6-0.1840-0.04 to 0.40.1082 0.0% VAS Fatigue 1-0.0396-0.51 to 0.59.8887 NA Abbreviations: NA, not applicable; POMS, Profile of Mood States; VAS, visual analog scale.
etable 6. Summary of pain univariate moderator analysis Effect Moderator Effects (k) Δ or β 95% CI P Value I 2 Demographics Nationality United States 11-0.2860 0.07 to 0.50.0092 35.3% Other 7-0.8377 0.61 to 1.06.0000 30.6% Sex Male 1-0.6345-0.38 to 1.65.2211 NA Female 4-0.6574-0.26 to 1.06.0012 34.7% Mixed 13-0.4874-0.23 to 0.74.0002 32.9% Age (years) 18-0.0140-0.03 to -0.01.0450 31.3% Baseline score (T score) 17-0.0339-0.01 to 0.06.0140 43.1% Intervention Characteristics Intervention mode Art 1-0.2234-0.56 to 1.00.5773 0.0% Dance 0 -NA NA NA NA Music 16-0.5608-0.34 to 0.78.0000 27.4% Writing 1-0.6345-0.37 to 1.64.2173 NA Therapeutic monitoring Creative arts therapist 3 0.2668-0.19 to 0.72.2544 44.9% No creative arts therapists 15 0.6049-0.38 to 0.83.0000 0.0% Intervention type Individual 17 0.5642-0.35 to 0.77.0000 15.6% Group 1 0.2234-0.56 to 1.00.5572 0.0% Session type Single session 11-0.5274-0.25 to 0.81.0002 20.4% Multisession 7-0.5566-0.23 to 0.88.0007 6.6% Session duration (minutes) 14-0.0050-0.01 to 0.00.0098 6.4% Program duration (weeks) 18-0.0070-0.06 to 0.07.8280 9.2% Study Characteristics Intervention period During treatment 14 0.4633 0.23 to 0.69.0001 34.0% Posttreatment 4 0.7744 0.38 to 1.17.0001 0.0%
Intervention setting Inpatient 8-0.7791-0.55 to 1.01.0000 0.0% Outpatient 10-0.2995-0.06 to 0.54.0133 57.7% Other 0 -NA -NA NA NA Intervention confound Confounded 15 0.6049-0.38 to 0.83.0000 35.5% Not confounded 3 0.2668-0.19 to 0.73.2544 0.0% Homogeneity of group - Homogeneous 6 0.8743-0.57 to 1.18.0000 25.4% Heterogeneous 12 0.3714-0.15 to 0.59.0011 27.2% Type of comparison No treatment 5-0.7556-0.39 to 1.13.0001 0.0% Waiting list 1-0.2234-0.52 to 0.97.5570 NA Usual care 8-0.4721-0.18 to 0.76.0014 34.3% Placebo 4-0.4926-0.23 to 0.96.0379 80.5% Outcome measure VAS Pain 12-0.4608-0.21 to 0.72.0004 36.8% MPQ 2-0.7053-0.10 to 1.31.0222 0.0% Other 4-0.6863-0.25 to 1.12.0019 34.2% Abbreviations: MPQ, McGill Pain Questionnaire; NA, not applicable; VAS, visual analog scale.
etable 7. Summary of QOL univariate moderator analysis Effect Moderator Effects (k) Δ or β 95% CI P Value I 2 Demographics Nationality United States 5-0.4911-0.23 to 0.75.0002 41.0% Other 1-0.5088-0.11 to 1.13.1090 NA Sex Male 0 -NA NA NA NA Female 5-0.4900-0.20 to 0.78.0008 NA Mixed 1-0.5027-0.05 to 0.95.0269 41.0% Age (years) 6-0.0146-0.03 to 0.06.5039 21.4% Baseline score (T score) 6-0.0347-0.04 to 0.11.3884 21.4% Intervention Characteristics Intervention mode Art 1-0.5088-0.11 to 1.31.1090 NA Dance 2-0.7071-0.24 to 1.17.0029 NA Music 3-0.3914-0.08 to 0.71.0153 63.4% Writing 0 NA NA NA NA Therapeutic monitoring Creative arts therapist 6 0.4953-0.25 to 0.74.0001 21.4% No creative arts therapists 0 NA -NA NA NA Intervention type Individual 4 0.4155-0.14 to 0.70.0039 27.7% Group 2 0.7071-0.24 to 1.17.0029 NA Session type Single session 0 -NA -NA NA NA Multisession 6-0.4953-0.25 to 0.74.0001 21.4% Session duration (minutes) 4-0.0187-0.01 to 0.03.0757 60.7% Program duration (weeks) 6-0.0118-0.06 to 0.03.6080 21.4% Study Characteristics Intervention period During treatment 3 0.3819 0.10 to 0.67.0090 15.7% Posttreatment 3 0.7638 0.32 to 1.21.0008 47.5% Intervention setting Inpatient 0 -NA NA NA NA Outpatient 5-0.4900-0.20 to 0.78.0008 41.0% Other 1-0.5027-0.05 to 0.95.0269 NA Intervention confound Confounded 2 0.3477-0.02 to 0.67.0349 NA
Not confounded 4 0.6774-0.31 to 1.04.0002 14.3% Homogeneity of group - Homogeneous 5 0.4900-0.20 to 0.77.0008 41.0% Heterogeneous 1 0.5027 0.05 to 0.95.0269 0.0% Type of comparison No treatment 0 NA NA NA NA Waiting list 3-0.7638-0.31 to 1.21.0008 47.6% Usual care 3-0.3819-0.10 to 0.67.0090 15.7% Placebo 0 NA NA NA NA Outcome Measure FACT 3-0.4435-0.11 to 0.77.0085 73.0% Other 3-0.5508-0.19 to 0.90.0022 16.3% Abbrevations: FACT, Functional Assessment of Cancer Therapy; NA, not applicable; QOL, quality of life. efigure. Funnel plots (following pages)
Standard Error 0.0 Anxiety Effects Mean Δ 95% Confidence Interval 0.1 0.2 0.3 0.4 0.5-2.0-1.0 0.0 1.0 2.0 Mean Δ
Standard Error 0.0 Depression Effects Mean Δ 95% Confidence Interval 0.1 0.2 0.3 0.4 0.5-2.0-1.0 0.0 1.0 2.0 Mean Δ
Standard Error 0.0 Pain Effects Mean Δ 95% Confidence Interval 0.1 0.2 0.3 0.4 0.5-2.0-1.0 0.0 1.0 2.0 Mean Δ
Standard Error 0.0 Fatigue Effects Mean Δ 95% Confidence Interval 0.1 0.2 0.3 0.4 0.5-2.0-1.0 0.0 1.0 2.0 Mean Δ
Standard Error 0.0 Quality of Life Effects Mean Δ 0.1 95% Confidence Interval 0.2 0.3 0.4 0.5 0.6 0.7 0.8-2.5-2.0-1.5-1.0-0.5 0.0 0.5 1.0 1.5 2.0 2.5 Mean Δ