Effect of Calcium and Vitamin D Co-supplementation on Blood Pressure: A Systematic Review and Meta-Analysis

PurposeVitamin D and calcium insufficiency has been related to elevated blood pressure (BP) and cardiovascular complications. This systematic review and meta-analysis investigates the effect of calcium and vitamin D co-supplementation on BP.MethodsA systematic search was conducted of electronic databases, including Web of Sciences, MEDLINE, Scopus, EMBASE, and the Cochrane Library, along with searches of gray literature and reference lists from included trials. There were no language restrictions, and the databases were searched from inception to October 2019. Randomized controlled trials, using calcium and vitamin D co-supplementation and reporting mean systolic BP and/or diastolic BP (DBP) with SDs, were included in the systematic review. Articles were evaluated independently by 2 researchers based on inclusion and exclusion criteria. A random effects model was conducted to synthesize the data.FindingsEight trials were included in the meta-analysis. Meta-analysis of these 8 trials indicated a nonsignificant reduction in systolic BP in the calcium and vitamin D co-supplementation group compared with control (standardized mean difference, −0.23; 95% CI, −0.52 to 0.06). Conversely, there was a statistically significant decrease in DBP (standardized mean difference, −0.29; 95% CI, −0.55 to −0.02). Subgroup analysis suggested that young adults achieve a greater reduction in DBP than other age groups.ImplicationsCalcium and vitamin D co-supplementation can modulate DBP and should be investigated more specifically in large, well-designed trials of hypertensive populations. (Clin Ther. 2020;42:XXX–XXX) © 2020 Elsevier HS Journals, Inc.     

The Effect of Anastrozole on the Lipid Profile: Systematic Review and Meta-analysis of Randomized Controlled Trials

PurposeWe aimed to investigate the impact of anastrozole administration on the traditional components of the lipid profile (ie, total cholesterol [TC], LDL-C, HDL-C, and triglycerides [TGs]) by means of a systematic review and meta-analysis of randomized controlled trials.MethodsWe searched the PubMed/Medline, Scopus, Embase, and Web of Science databases for relevant randomized controlled trials published in the English language until January 18, 2022. The weighted mean difference (WMD) and 95% CIs were calculated using a random-effects model (DerSimonian and Laird methods).FindingsAnastrozole administration significantly lowered TC concentrations when the treatment duration was ≤3 months (WMD = ?2.73 mg/dL; 95% CI, ?5.09 to ?0.38 mg/dL; P = 0.02) and when the baseline TC concentration was ≥200 mg/dL (WMD = ?3.64 mg/dL; 95% CI, ?6.30 to ?0.98 mg/dL; P = 0.007). HDL-C levels decreased after anastrozole administration when the treatment duration was >3 months (WMD = ?1.67 mg/dL; 95% CI, ?3.24 to ?0.10 mg/dL; P = 0.03). Anastrozole administration had no impact on TG or LDL-C values.ImplicationsAnastrozole administration in humans can decrease TC and HDL-C levels but has no effect on LDL-C or TG concentrations.     

补充维生素D对血压影响的系统评价

目的 系统评价补充维生素D对血压的影响,为临床治疗提供依据。方法计算机检索CENTRAL、PubMed、EMbase、CNKI和WanFang Data,收集关于补充维生素D对血压影响的随机对照试验,检索时限均为建库至2011年8月。由2位评价者根据纳入标准独立筛选文献、提取资料并评价质量后,采用RevMan5．0软件进行Meta分析。结果最终纳入8个RCT,共907例患者。采用改良ladad评分评价纳入研究的方法学质量,7篇为4～7分,1篇低于4分。Meta分析结果显示：与安慰剂相比,补充维生素D对收缩压、舒张压的影响差异均无统计学意义。结论目前研究证据显示,与安慰剂相比,补充维生素D无论是对舒张压还是收缩压均无显著影响。受纳入研究数量所限,上述结论尚需开展更多设计严谨、大样本、多中心的随机对照试验加以验证。     

Effects of Vitamin D Supplementation on Bone Health and Bone-related Parameters in HIV-infected Patients: A Systematic Review and Meta-analysis

PurposeThere is growing evidence that bone health is decreased in individuals with HIV infection. Vitamin D deficiency is also highly prevalent among HIV-infected patients. The literature was systematically reviewed to determine whether bone health and bone-related parameters may improve with vitamin D supplementation in HIV-infected individuals.MethodsFour databases were systematically searched for randomized clinical trials of vitamin D supplementation in HIV infection, published from January 1990 to September 2021. No language or publication restrictions were applied. Standardized mean differences (SMD) with 95% CIs are reported. A random-effects model was used to perform meta-analysis.FindingsTen studies met the inclusion criteria (N = 733 participants at study completion). The mean ages of the patients in the included trials ranged from 10 to 49 years. The meta-analysis indicated that with vitamin D supplementation, serum 25-hydroxy vitamin D (25[OH]D) level was significantly increased (SMD, 1.86; 95% CI, 1.02 to 2.70; I² = 94.4%), but there were no significant effects on levels of serum 1,25-dihydroxy vitamin D (1,25-[OH]₂D) (SMD, 0.29; 95% CI, –0.07 to 0.64; I² = 67.4%), total bone mineral density (SMD, 0.07; 95% CI, –0.23 to 0.37; I² = 00.0%), spine bone mineral density (SMD, 0.15; 95% CI, –0.19 to 0.49; I² = 17.3%), and parathyroid hormone level (SMD, –0.18; 95% CI, –0.37 to 0.02; I² = 1.2%) in HIV-infected patients.ImplicationsThis study showed that vitamin D supplementation can improve serum 25(OH)D in HIV-infected patients. The effects of vitamin D supplementation on other bone health–related parameters such as bone mineral density and parathyroid hormone in HIV-infected patients need to be further investigated in larger-scale, well-designed randomized, controlled trials.     

The Effect of Raloxifene Treatment on Lipid Profile in Elderly Individuals: A Systematic Review and Meta-analysis of Randomized Clinical Trials

PurposeTo perform a systematic review and meta-analysis of randomized clinical trials (RCTs) to elucidate the effects of raloxifene on the lipid profile in elderly individuals.MethodsA systematic review and meta-analysis of RCTs was performed following the PRISMA statement. Data on triglycerides (TGs), total cholesterol (TC), HDL-C, and LDL-C were extracted. Relevant publications up to October 2020 were detected through searches in the PubMed/MEDLINE, Web of Science, Scopus, and Embase databases. Changes were reported as weighted mean differences (WMDs) and 95% CIs using random-effects models.FindingsNine studies were selected, with a duration of intervention ranging from 2 and 12 months and a raloxifene dose of 60 to 120 mg/d. Studies were performed in healthy individuals and in those with disorders, such as osteoporosis, type 2 diabetes, and kidney disease required long-term hemodialysis. Overall, TG (WMD, −6.50 mg/dL; 95% CI, −34.18 to 21.20 mg/eL; P = 0.646), LDL-C (WMD, −17.86 mg/dL; 95% CI, −42.44 to 6.72 mg/dL; P = 0.154), and HDL-C (WMD, 2.35 mg/dL; 95% CI, −1.14 to 5.84 mg/dL; P = 0.187) levels did not change significantly after the administration of raloxifene. In contrast, TC levels decreased after raloxifene therapy (WMD, −6.59 mg/dL; 95% CI, −13.13 to −0.05 mg/dL; P = 0.048).ImplicationsRaloxifene therapy decreased TC levels but did not alter TG, HDL-C, and LDL-C concentrations in elderly individuals. Regarding the LDL-C levels, although the finding lacked statistical significance, we believe that there was a mean reduction that deserves further clinical attention as much as TC.     

对系统评价/Meta分析报告规范的系统评价

目的全面收集系统评价/Meta分析的报告规范并对其进行评价,为系统评价/Meta分析的规范化发表及传播提供帮助。方法电子检索Ovid MEDLINE(1996～2010)及EMbase(截至2010年4月),纳入系统评价/Meta分析报告规范的文献,检索词包括guideline、report、systematic reviews、meta-analyses。通过阅读文题及摘要,排除无明显相关性的文献(针对具体疾病的系统评价,某一疾病的临床指南,以及仅讨论如何进行系统评价而未关注如何进行系统评价的报道等),而后进一步阅读全文,从纳入文献中提取如何报告系统评价/Meta分析的部分,并据其纳入原始研究设计的类型如随机对照试验、观察性研究、诊断性试验进行分类。结果初检获得285篇文献,最终纳入26篇文献。其中随机对照试验的系统评价/Meta分析报告规范有8篇,非随机对照试验(观察性研究)的系统评价/Meta分析报告规范2篇,诊断性试验的系统评价/Meta分析报告规范0篇,动物实验的系统评价/Meta分析报告规范1篇,针对系统评价/Meta分析的检索策略的报告规范2篇,评估系统评价/Meta分析质量的5篇,研究报告规范对系统评价/Meta分析质量影响的6篇。有2个指南更新。结论目前系统评价/Meta分析报告规范数量较多,其中QUOROM及其更新版本PRISMA被众多期刊广泛采纳。报告规范有利于提高系统评价和Meta分析的报告质量,尚需制定针对具体专业系统评价/Meta分析的报告规范。     

Effects of Relaxation Therapy on Anxiety Disorders: A Systematic Review and Meta-analysis

AIM

To explore the effect of relaxation therapy applied to people with anxiety disorders.

Effect of the Dual Dual Glucose-Dependent Insulinotropic Peptide/Gulcagon-like Peptide 1 Receptor Agonist Tirzepatide on Lipid Profile and Waist Circumference: A Systematic Review and Meta-analysis

PurposeTirzepatide, a dual glucose-dependent insulinotropic peptide and glucagon-like peptide 1 receptor agonist, has been approved by the US Food and Drug Administration for the treatment of type 2 diabetes. The purpose of this meta-analysis is to evaluate the impact of tirzepatide on lipid profile and waist circumference (WC), both of which are risk factors of cardiovascular diseases.MethodsThe PubMed, Embase, Cochrane Library, Web of Science, and ClinicalTrials.gov databases were systematically searched for articles published from database inception to July 31, 2022. This meta-analysis included 7 randomized controlled trials with a minimum duration of 12 weeks that compared tirzepatide with placebo or other antidiabetic medications. The random-effects model was used to estimate mean differences in lipid profile and WC from baseline. The Cochrane risk-of-bias tool for randomized trials, version 2 was used to assess the outcome's risk of bias. We evaluated the evidence using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system.FindingsA total of 8 articles from 7 trials with 7151 participants were included. All 3 eligible maintenance doses of tirzepatide (5, 10, and 15 mg once a week) were effective in increasing total cholesterol (TC) (P < 0.05), HDL-C (P < 0.05), VLDL-C (P < 0.01), triglyceride (TG) (P < 0.01), and WC (P < 0.01) changes from baseline compared with control agents including placebo, semaglutide, dulaglutide, and degludec. Although the evidence for VLDL-C and TGs by GRADE were high or moderate, the evidences for TC, HDL-C, and WC were low or moderate. Only 5mg once-weekly tirzepatide (P < 0.05), not 10 or 15 mg, could induce significant alteration in LDL-C before sensitivity analysis. The evidence by GRADE was moderate.ImplicationsTirzepatide had superiority over placebo or other antidiabetic agents in controlling lipid and WC levels. However, the levels of evidence by GRADE varied greatly across different outcome indicators. Limitations of the study include evaluating secondary outcomes of original trials for the meta-analyses, not assessing the effect of baseline lipid-lowering therapy on lipid levels, and not exploring the bias induced by glycemic improvement and weight loss.     

Does Omega-3 Fatty Acid Supplementation Have Favorable Effects on the Lipid Profile in Postmenopausal Women? A Systematic Review and Dose–response Meta-analysis of Randomized Controlled Trials

PurposeMenopause is associated with disturbances in the metabolism of lipids. Moreover, during the postmenopausal period, female subjects are more prone to develop dyslipidemia. Omega-3 fatty acids, which exert cardioprotective, anti-inflammatory, and lipid-lowering actions, are commonly recommended in postmenopausal women. However, their effect on serum lipids in this population remains unclear. This systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted to clarify this research question.MethodsWe systematically searched the Web of Science, Scopus, PubMed/MEDLINE, and EMBASE databases from their inception until January 3, 2022. The DerSimonian and Laird random-effects model was used to combine effect sizes.FindingsOmega-3 fatty acid supplementation resulted in a decrease in triglyceride concentrations (weighted mean difference [WMD], –17.8 mg/dL; 95% CI, –26 to –9.6; P < 0.001), particularly in the RCTs that lasted ≤16 weeks (WMD, –18.6 mg/dL), when the baseline triglyceride concentrations were ≥150 mg/dL (WMD, –22.8 mg/dL), in individuals with a body mass index ≥30 kg/m² (WMD, –19.3 mg/dL), and when the dose of omega-3 fatty acids was ≥1 g/d (WMD, –21.10 mg/dL). LDL-C (WMD, 4.1 mg/dL; 95% CI, 1.80 to 6.36; P < 0.001) and HDL-C (WMD, 2.1 mg/dL; 95% CI, 0.97 to 3.2; P < 0.001) values increased. Total cholesterol levels (WMD, –0.15 mg/dL; 95% CI, –4 to 3.74; P = 0.94) remained unchanged after administration of omega-3 fatty acids.ImplicationsIn postmenopausal women, supplementation with omega-3 fatty acids resulted in a significant reduction in triglyceride concentrations and a modest elevation in HDL-C and LDL-C levels, whereas this intervention did not affect total cholesterol values.     

Effects of Perioperative Dexmedetomidine on Postoperative Mortality and Morbidity: A Systematic Review and Meta-analysis

Purpose

Major postoperative complications translate into increased health care resource utilization, prolonged hospital stays, and increased mortality. We aimed to assess the effects of perioperative dexmedetomidine use on postoperative mortality and the prevalence of major complications after cardiac and noncardiac surgery.

Effects of Smartphone-Based Mobile Learning in Nursing Education: A Systematic Review and Meta-analysis

Purpose

A systematic review and meta-analysis was conducted to evaluate the effects of smartphone-based mobile learning for nurses and nursing students.

The Effects of Fenugreek on Cardiometabolic Risk Factors in Adults: A Systematic Review and Meta-analysis

Cardiovascular disease (CVD) is the leading causes of mortality across the world. Some earlier studies have revealed the beneficial effects of fenugreek on the risk factors for CVDs. However, a systematic review and meta-analysis is needed to clarify its effectiveness. Accordingly, the purpose of this study was to assess the impacts of fenugreek on several cardiometabolic risk factors in adult populations. Four electronic databases including PubMed/Medline, Scopus, Embase and Cochrane Library were searched from 2000 to 31 July 2019 to identify studies with English language. Controlled clinical trials on fenugreek reported at least one of cardiometabolic risk factors was included. Pooled effect sizes were reported as Weighted Mean Differences (WMDs) and 95% confidence intervals (CIs). Trials were pooled using a random effect model with DerSimonian and Laird method. Finally, out of 2738 publications, 12 articles were included in the meta-analysis. We found that fenugreek seed vs. placebo can reduce FBS (WMD: -12.94 mg/dL, 95%CI: -21.39 mg/dL, -4.49; I²: 85.0%, p _{heterogeneity} = 0.0001), HbA1c (WMD: -0.58%%, 95% CI: -0.99, -0.17%; I²:0%, p _{heterogeneity} =0.61), total cholesterol (WMD:-9.13 mg/dL, 95% CI: -13.83, -4.43; I²:0, p _{heterogeneity} = 0.48), and low-density lipoprotein cholesterol (WMD:-11.11 mg/dL, 95% CI: -20.32, -1.90; I²:1.41%, p _{heterogeneity} = 0.36). However, no significant changes were observed in other cardiometabolic parameters. Fenugreek seed as an adjuvant therapy may reduce serum levels of FBS, LDL-C and HbA1c. However, due to high heterogeneity in glycemic status, findings must be interpreted with great caution. More placebo-controlled clinical trials are warranted to further assess the effectiveness of fenugreek as a complementary therapy to control cardio-metabolic risk factors.     

Statins and Cognition: A Systematic Review and Meta-analysis of Short- and Long-term Cognitive Effects

ObjectiveTo evaluate the effect of statins on short-term cognitive function and the long-term incidence of dementia.Patients and MethodsA systematic search was performed of MEDLINE, EMBASE, and the Cochrane Central Register from their inception to April 25, 2013. Adults with no history of cognitive dysfunction treated with statins were included from high-quality randomized controlled trials and prospective cohort studies after formal bias assessment.ResultsSixteen studies were included in qualitative synthesis and 11 in quantitative synthesis. Short-term trials did not show a consistent effect of statin therapy on cognitive end points. Digit Symbol Substitution Testing (a well-validated measure of cognitive function) was the most common short-term end point, with no significant differences in the mean change from baseline to follow-up between the statin and placebo groups (mean change, 1.65; 95% CI, –0.03 to 3.32; 296 total exposures in 3 trials). Long-term cognition studies included 23,443 patients with a mean exposure duration of 3 to 24.9 years. Three studies found no association between statin use and incident dementia, and 5 found a favorable effect. Pooled results revealed a 29% reduction in incident dementia in statin-treated patients (hazard ratio, 0.71; 95% CI, 0.61-0.82).ConclusionIn patients without baseline cognitive dysfunction, short-term data are most compatible with no adverse effect of statins on cognition, and long-term data may support a beneficial role for statins in the prevention of dementia.     

Association Between the Overall Risk of Prostate Cancer and Use of Calcium Channel Blockers: A Systematic Review and Meta-analysis

PurposeAlthough calcium channel blockers (CCBs) are now commonly prescribed to treat hypertension as a first-line drug therapy, their impact on prostate cancer (PCa) is unclear. This systematic review and meta-analysis was conducted to determine the association between CCB use and the overall risk of PCa.MethodsPubMed, EMBASE, and Cochrane were searched up to December 26, 2019, stratified according to statistical method of outcome [odd ratios (ORs), relative ratios (RRs), hazard ratios (HRs)] and cumulative duration of CCB use. The quality assessment of included studies was evaluated by using the Newcastle–Ottawa Scale. Fixed effects models were used to study the association between CCB use and the risk of PCa. Between-study heterogeneity was quantified by using Cochran's Q-statistic and I² statistics. Sensitivity analysis was performed by excluding the studies one by one, and publication bias was analyzed by using funnel plots.FindingsNineteen studies with 1,418,407 patients were identified for inclusion in the meta-analysis, which was based on the comparison of cohort studies, nested case–control studies, and case–control studies. Pooled estimates showed a RR of 1.08 (95% CI, 1.05–1.11; P < 0.00001) and a HR of 1.07 (95% CI, 1.02–1.13; P = 0.008) for association between CCB use and the risk of PCa. In addition, the results of subgroup analysis showed that CCB users of <5 years had an 8% increased overall risk of PCa (RR, 1.08; 95% CI, 1.04–1.12; P = 0.0001), and CCB users of 5–10 years had a 13% increased overall risk of PCa (RR, 1.13; 95% CI, 1.04–1.23; P = 0.003).ImplicationsCCB use had a tendency to increase the overall risk of PCa, and cumulative duration of CCB use might also be positively correlated with the overall risk of PCa.     

The Effect of Vitamin D Supplementation on Treatment-Induced Pain in Cancer Patients: A Systematic Review

ObjectivesDespite the widespread use of complementary and alternative medicine by patients and physicians alike, there is no accurate evidence regarding the effects of vitamin D supplementation on treatment-induced pain in cancer patients. Thus, the aim of this systematic review of randomized controlled trials (RCTs) was to evaluate the impact of vitamin D administration on therapy-related pain in subjects diagnosed with malignant disorders.Review analysis methodsWe searched the Web of Science, Scopus, PubMed/Medline, Embase, and Google Scholar databases up to October 2020 to identify published RCTs that investigated the use of vitamin D in the management of treatment-induced pain in individuals with cancer.ResultsNine RCTs were detected. The median duration of the intervention was of 24 weeks (range 12-52 weeks) and dose of vitamin D employed was 2000-50000 IU of vitamin D3 weekly orally each day. Six RCTs reported a significant reduction in pain, whereas three did not detect a notable decrease of this variable. Of the six studies that reported an alleviation of pain, an RCT which recruited 60 participants and lasted for 24 weeks consisted of supplementation with high doses of vitamin D2 weekly for 8 weeks in women receiving anastrozole as adjuvant therapy, then supplementation with vitamin D2 monthly for 4 months, effectively alleviated the aromatase inhibitor-associated musculoskeletal syndrome (AIMSS). The results of the same RCT also suggested a beneficial effect of vitamin D on musculoskeletal pain.ConclusionsOur results suggest that the supplementation with high doses of vitamin D in cancer patients with low serum levels of vitamin D, can be effective in reducing treatment-related pain.     

Colchicine for Stroke Prevention: A Systematic Review and Meta-analysis

Purpose

There has been recent interest in the role of colchicine in cardiovascular diseases, given the implication of inflammation in the pathogenesis of atherothrombosis. This systematic review assessed the role of colchicine in preventing primary or secondary stroke/transient ischemic attack (TIA) in an adult population.

Edaravone for Acute Ischemic Stroke: A Systematic Review and Meta-analysis

PurposeThe management of acute stroke is challenging. The aim of this meta-analysis was to determine the efficacy and tolerability of edaravone, with or without thrombolytic therapy, in the treatment of patients with acute ischemic stroke.MethodsThe PubMed, EMBASE, and Cochrane databases were searched for randomized controlled trials (RCTs) and cohort studies. Mean differences (MD), risk ratios (RR), 95% confidence interval (CI), and heterogeneity were calculated.FindingsTotals of nine RCTs and four cohort studies were included, for a total of 2102 patients. In patients with acute ischemic stroke, edaravone monotherapy was associated with significantly improved Barthel Index of functioning in activities for daily living (MD, 23.95; 95% CI, 18.48 to 29.41; P < 0.001) and neurologic deficit, (as measured using the National Institutes of Health Stroke Scale score) (MD = –3.49; 95% CI, –5.76 to 1.22; P = 0.003), on short-term follow-up. However, edaravone was not associated with an improved rate of death or disability (RR = 0.75; 95% CI, 0.45 to 1.23; P = 0.25) on long-term follow-up.When plus to thrombolytic therapy, edaravone was associated with significant improvements in recanalization rate (RR = 1.71; 95% CI, 1.05 to 2.77; P = 0.03) and neurologic deficit (MD = 3.97; 95% CI, 5.14 to 2.79; P < 0.001), without an increase in the prevalence of bleeding events (RR = 1.11; 95% CI, 0.76 to 1.62; P = 0.59). However, edaravone did not have a significant effect on death or disability (RR = 0.85; 95% CI, 0.69 to 1.04; P = 0.12).ImplicationsBased on the findings from the present meta-analysis, edaravone was an effective and well-tolerated neuroprotective agent in these patients with ischemic stroke. With the use of edaravone, activities of daily living and neurologic deficits, along with recanalization rates, were improved on short-term follow-up, but the long-term effects still need confirmation in larger-scale clinical trials.     

Yoga as Antihypertensive Lifestyle Therapy: A Systematic Review and Meta-analysis

Objective

To investigate the efficacy of yoga as antihypertensive lifestyle therapy and identify moderators that account for variability in the blood pressure (BP) response to yoga.

Risk Factors for Herpes Zoster: A Systematic Review and Meta-analysis

Objective

To systematically review studies examining risk factors for herpes zoster (HZ).

Effects of Cognitive and Mental Health Factors on the Outcomes Following Carpal Tunnel Release: A Systematic Review and Meta-analysis

ObjectiveTo determine the effects of the cognitive and mental health factors on the outcomes after carpal tunnel release (CTR).Data SourcesEmbase, PubMed/MEDLINE, Web of Science, Cumulative Index to Nursing and Allied Health, and Cochrane Central Register of Controlled Trials databases from inception to August 14, 2021.Study SelectionRandomized controlled trials and observational studies of patients with CTR were included. The included studies aimed to determine the effect of the cognitive (catastrophic thinking, kinesiophobia, self-efficacy) or mental health factors (symptoms of anxiety and depression) on the outcomes at least 3 months post CTR.Data ExtractionTwo independent reviewers performed data extraction and assessed the risk of bias. Data were extracted using a standardized protocol and reporting forms. The risk of bias of the included studies was assessed using the Quality in Prognosis Studies risk-of-bias tool. Random-effects models were used for meta-analysis.Data SynthesisA total of 15 studies involving 2599 patients were included in this systematic review. The majority of studies indicate a significant association between the cognitive or mental health factors and outcomes after CTR. Quantitative analysis showed a moderate association of symptoms of depression on symptom severity (n=531; r=0.347; 95% CI, 0.205-0.475; P≤.0001), function (n=386; r=0.307; 95% CI, 0.132-0.464; P=.0008), and pain (n=344; r=0.431; 95% CI, 0.286-0.558; P≤.0001). In general, the risk of bias in the included studies was low.ConclusionsThis systematic review and meta-analysis showed that symptoms of depression have a moderate association with symptom severity, function, and pain after CTR. Symptoms of anxiety, catastrophic thinking, and self-efficacy are also important indicators of poor postsurgery outcomes. Physicians, physical therapists, and occupational therapists should consider evaluating these variables in patients undergoing CTR.