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ethnicity&#44; and lifestyle factors of patients&#44; the etiology of atopic dermatitis has not been fully clarified&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#8211;9</span></a> Currently&#44; topical application of emollients and anti-inflammation agents is still the basic strategy for treating atopic dermatitis&#46;<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">10&#44;11</span></a> The topical therapy is not effective for the treatment among a considerable proportion of moderate-to-severe patients&#44;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> which may cause a series of psychological consequences&#44; such as sleep disturbance&#44; anxiety&#44; depression&#44; and financial strain&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> Meanwhile&#44; psychological factors have also been shown to aggravate skin symptoms&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> Therefore&#44; psychological interventions are considered an indispensable element of multidisciplinary management strategy for atopic dermatitis&#46;<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">14&#44;15</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Up to now&#44; several original studies<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">16&#8211;18</span></a> have investigated the therapeutic effects of various psychological intervention strategies on atopic dermatitis&#46; Meanwhile&#44; some meta-analyses<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">19&#44;20</span></a> have also systematically evaluated the role of psychological and educational interventions in treating atopic dermatitis&#46; However&#44; the results of previously published studies of psychological interventions for atopic dermatitis are conflicting&#46; It&#8217;s noted that the therapeutic effects of psychological interventions may change according to the variations of types of psychological interventions&#46;<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">21&#44;22</span></a> However&#44; different psychological interventions were combined as an individual interventional strategy in the previous meta-analyses&#44;<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">19&#44;20</span></a> which may cause conflicting findings&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">As an indispensable part of psychological interventions&#44; behavioral therapy refers to the application of modern theories of learning and conditioning in the treatment of behavior disorders&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a> Currently&#44; many behavioral techniques have been used in clinical practice&#44; such as cognitive behavioral therapy&#44; habit-reversal therapy&#44; and dialectical behavior therapy&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a> Of these available behavioral techniques&#44; habit-reversal therapy<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a> and cognitive behavioral therapy<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">25&#44;26</span></a> have been used successfully in dermatology&#46; Habit-reversal therapy was initially described by Azrin and Nunn as a competing response produced by tightening muscles with antagonists&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a> Habit-reversal therapy consists of multiple components&#44; but competing response training and awareness training represent its most effective techniques&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a> While&#44; cognitive behavioral therapy is a combination of cognitive and behavioral approaches&#44; which can help the patient recognize his distorted thoughts and ineffective behaviors&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Several studies<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">24&#44;26</span></a> have explored the potential of habit-reversal therapy and cognitive behavioral therapy in managing atopic dermatitis&#46; Bewley has reported that atopic dermatitis patients who received three weeks of habit-reversal therapy had significantly better atopic dermatitis scores than those of the topical treatments alone&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a> Goyonlo et al&#46; suggested that cognitive behavioral therapy helped dermatitis patients improve clinical severity scores&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a> To our knowledge&#44; there has been no relevant meta-analysis evaluating the effects of behavioral interventions on atopic dermatitis&#46; Therefore&#44; the authors conducted the present meta-analysis to assess the effects of separate behavioral interventions on health outcomes in atopic dermatitis patients&#46; The authors aimed to provide a definitive evidence-based recommendation for behavioral interventions in atopic dermatitis patients&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Study design</span><p id="par0030" class="elsevierStylePara elsevierViewall">This systematic review and meta-analysis was carried out following the structure recommended by the Cochrane Handbook&#44;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a> and was reported in strict accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis &#40;PRISMA&#41; checklist&#44;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">31</span></a> thus strongly ensuring the transparency and reliability of conducting the current meta-analysis&#46; All these fulfill the requirement of registering a formal protocol in a public platform&#44; therefore the authors did not further register a protocol for this meta-analysis&#46; This study did not require ethical approval and the patient&#8217;s informed consent&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Selection criteria</span><p id="par0035" class="elsevierStylePara elsevierViewall">Two independent reviewers strictly followed the criteria to select studies from the retrieved records&#46; When there was disagreement about the literature retrieval&#44; the authors resolved it by consulting a third reviewer&#46; Three steps were designed for study selection&#58; &#40;a&#41; Removal of duplicate studies based on EndNote software&#59; &#40;b&#41; Initial eligibility assessment based on the titles and abstracts screening&#59; and &#40;c&#41; Final eligibility assessment based on full-text evaluation&#46;</p><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Inclusion criteria</span><p id="par0040" class="elsevierStylePara elsevierViewall">Eligibility of each study was evaluated using the PICOS acronym&#44; including patients&#44; intervention&#44; comparison&#44; outcome&#44; and study design&#58; &#40;a&#41; Patients were diagnosed with atopic dermatitis by a physician with recognized criteria &#40;<span class="elsevierStyleItalic">P acronym</span>&#41;&#59; &#40;b&#41; Patients in the experimental group were instructed to receive behavioral interventions in addition to usual medical care for atopic dermatitis &#40;<span class="elsevierStyleItalic">I acronym</span>&#41;&#59; &#40;c&#41; Patients in the control group received usual medical care alone &#40;<span class="elsevierStyleItalic">C acronym</span>&#41;&#59; &#40;d&#41; At least one of eczema severity&#44; itching intensity&#44; and scratching severity was reported effectively &#40;<span class="elsevierStyleItalic">O acronym</span>&#41;&#59; and &#40;e&#41; Patients were randomly assigned into different groups &#40;<span class="elsevierStyleItalic">S acronym</span>&#41;&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Exclusion criteria</span><p id="par0045" class="elsevierStylePara elsevierViewall">Studies were excluded from the following criteria&#58; &#40;a&#41; Behavioral interventions were designed as one part of the psychological protocol rather than separate intervention&#59; &#40;b&#41; Data about correlation coefficient &#40;<span class="elsevierStyleItalic">r</span>&#41; were not available&#59; &#40;c&#41; Ineligible study design was used&#44; such as quasi-randomized studies&#44; observational studies&#44; and animal studies&#59; and &#40;d&#41; Duplicate studies with overlapped samples&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Information sources</span><p id="par0050" class="elsevierStylePara elsevierViewall">The authors systematically searched three common English databases&#44; including PubMed&#44; EMBASE&#44; and the Cochrane Central Registry for Controlled Trials &#40;CENTRAL&#41;&#44; for retrieving relevant Randomized Controlled Trials &#40;RCT&#41; regarding the application of behavioral interventions in atopic dermatitis patients from their inception until February 2022&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Search strategy</span><p id="par0055" class="elsevierStylePara elsevierViewall">The search strategy was developed using subject terms and free words as follows&#58; &#8220;atopic dermatitis&#8221;&#44; &#8220;habit-reversal&#8221;&#44; &#8220;behavior therapy&#8221;&#44; &#8220;behavior modification&#8221;&#44; &#8220;behavior change&#8221;&#44; and &#8220;behavior treatment&#8221;&#46; Two independent reviewers conducted the search and updated weekly to avoid missing potentially eligible studies&#46; The authors also identified additional relevant studies through screening references of included studies and topic-related meta-analysis&#46; The authors did not restrict the publication status in literature retrieval&#46; Detailed search strategies of target databases were reported in Table S1&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Data extraction</span><p id="par0060" class="elsevierStylePara elsevierViewall">Two independent reviewers extracted the essential information from eligible studies using a pre-designed standard sheet&#46; The following information was extracted&#58; authors&#44; year of publication&#44; country&#44; sample size&#44; percentage of female patients&#44; the mean age of patients&#44; duration of atopic dermatitis&#44; details of grouping&#44; duration of intervention&#44; the number of sessions&#44; follow-up duration&#44; detailed outcomes of interest&#44; and information for quality assessment&#46; The authors also contacted authors to obtain more information if necessary&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Assessment of outcome</span><p id="par0065" class="elsevierStylePara elsevierViewall">This meta-analysis evaluated three outcomes&#44; including eczema severity&#44; itching intensity&#44; and scratching severity&#46; Eczema severity was measured using the Scoring the Severity of Atopic Dermatitis &#40;SCORAD&#41;&#44; the Modified SCORAD&#44; the AD Assessment Measure &#40;ADAM&#41;&#44; or the authors&#8217; original scoring methods&#44; and itching and scratching intensity was measured using a subjective Likert-type scale&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Risk of bias assessment</span><p id="par0070" class="elsevierStylePara elsevierViewall">Quality assessment was conducted by two independent reviewers using the Cochrane risk of bias assessment tool&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">32</span></a> In this assessment tool&#44; seven items were involved&#44; including random sequence generation &#40;selection bias&#41;&#44; allocation concealment &#40;selection bias&#41;&#44; blinding of participants and personnel &#40;performance bias&#41;&#44; blinding of outcome assessment &#40;detection bias&#41;&#44; incomplete outcome data &#40;attrition bias&#41;&#44; selective reporting bias &#40;reporting bias&#41;&#44; and other bias&#46; Each item would be classified as &#8220;low&#8221;&#44; &#8220;unclear&#8221;&#44; or &#8220;high&#8221; risk based on the actual information reported in studies&#46; Finally&#44; the overall quality of each study was appraised as either &#8220;low&#8221;&#44; &#8220;moderate&#8221;&#44; or &#8220;high&#8221; level&#46; Specifically&#44; the overall methodological quality was appraised as &#8220;high&#8221; if all items were classified as &#8220;low&#8221; risk&#44; &#8220;low&#8221; if at least one of the seven items was classified as &#8220;high&#8221; risk&#44; or &#8220;moderate&#8221; if at least one of the seven items was classified as &#8220;unclear&#8221; risk but no one was classified as &#8220;high&#8221; risk&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Statistical analysis</span><p id="par0075" class="elsevierStylePara elsevierViewall">In this meta-analysis&#44; the authors used Stata 14&#46;0 software &#40;State Corporation&#44; Lake Way&#44; Texas&#44; USA&#41; to calculate the effect size&#44; which was expressed as a correlation coefficient &#40;<span class="elsevierStyleItalic">r</span>&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">33</span></a> Statistical heterogeneity across studies was tested using Cochrane <span class="elsevierStyleItalic">Q</span><a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">34&#44;35</span></a> and I<span class="elsevierStyleSup">2</span> statistic&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">36</span></a> Studies were considered homogeneous if p&#8239;&#62;&#8239;0&#46;1 and I<span class="elsevierStyleSup">2</span> &#60; 50&#37;&#59; Otherwise&#44; they were regarded as heterogeneous&#46; The authors selected the random-effects model for all statistical analyses regardless of the level of statistical heterogeneity because this model incorporated the variance resulting from differences between studies and within studies into estimates calculation&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">35</span></a> The authors calculated the corresponding <span class="elsevierStyleItalic">r</span> value according to the data reported in the included studies using an online calculator&#44; namely the &#8220;Practical Meta-Analysis Effect Size Calculator&#8221;&#44; which was designed by Wilson et al&#46; to facilitate the computation of effect sizes for meta-analysis&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">37</span></a> The authors performed a sensitivity analysis to examine the robustness of results for eczema severity through the leave-one-out method&#46; Finally&#44; publication bias examination for meta-analysis of eczema severity was conducted using the Egger linear regression and Begg rank relationship methods although the cumulative number of eligible studies does not exceed 10&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">38</span></a></p></span></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Results</span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Literature search</span><p id="par0080" class="elsevierStylePara elsevierViewall">The authors retrieved 237 records from electronic databases using pre-designed search strategies&#46; After removing 36 duplicate records&#44; 201 unique studies were retained for initial eligibility evaluation&#46; The authors excluded a total of 194 ineligible studies after screening the titles and abstracts due to being unrelated to the topic &#40;n&#8239;&#61;&#8239;183&#41;&#44; registered study protocol &#40;n&#8239;&#61;&#8239;8&#41;&#44; and meta-analysis &#40;n&#8239;&#61;&#8239;3&#41;&#46; Then&#44; the authors retrieved the full texts of the remaining seven studies for further eligibility evaluation&#46; After excluding two ineligible studies due to ineligible topics&#44; five studies<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">39&#8211;43</span></a> were considered for meeting the selection criteria&#46; Moreover&#44; the authors identified another eligible study<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">44</span></a> from a previous meta-analysis&#46; Finally&#44; six RCTs<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">39&#8211;44</span></a> involving seven reports were included in this meta-analysis because the study by Ehlers et al&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">44</span></a> compared the effectiveness of 4 group treatments for atopic dermatitis&#46; The detailed process of selecting the study is indicated in <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Study characteristics</span><p id="par0085" class="elsevierStylePara elsevierViewall">Detailed basic characteristics of the included studies are presented in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; A total of 246 patients were included in the current study&#46;<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">39&#8211;44</span></a> Five studies<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">39&#8211;44</span></a> enrolled adult patients&#44; and pediatric patients were included in only one study&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">40</span></a> Among six included studies&#44; three studies<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">40&#8211;42</span></a> designed habit reversal behavioral therapy&#44; and another three<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">39&#44;43&#44;44</span></a> designed cognitive behavioral therapy for treating atopic dermatitis&#46; Three studies<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">40&#44;42&#44;44</span></a> assigned physician to evaluate outcomes&#59; two studies<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">41&#44;43</span></a> measured outcomes with the Scoring Atopic Dermatitis &#40;SCORAD&#41;&#59; and one study<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">39</span></a> used Atopic Dermatitis Assessment Measure &#40;ADAM&#41; to evaluate outcomes&#46; The effect sizes of included studies regarding target outcomes of interest are presented in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Risk of bias</span><p id="par0090" class="elsevierStylePara elsevierViewall">Only one study <a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">41</span></a> specifically introduced the method of generating random sequences and performing allocation&#46; All studies <a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">39&#8211;44</span></a> were rated as having an unclear risk for blinding participants and personnel&#44; and one study <a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">44</span></a> was rated as high risk for blinding of outcome assessment&#46; All studies <a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">39&#8211;44</span></a> were rated as low risk for attrition bias and reporting bias but high risk for other biases due to extremely insufficient sample size&#46; Detailed results of the quality assessment are presented in <a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Meta-analysis results</span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Eczema severity</span><p id="par0095" class="elsevierStylePara elsevierViewall">All included studies&#44;<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">39&#8211;44</span></a> involving seven reports with 246 patients&#44; evaluated the effect of behavioral interventions on eczema severity&#46; Heterogeneity examination indicated that all studies were homogeneous for analysis of eczema severity &#40;I<span class="elsevierStyleSup">2</span>&#8239;&#61;&#8239;0&#37;&#44; p&#8239;&#61;&#8239;0&#46;890&#41;&#46; Meta-analysis indicated that&#44; compared to traditional medical care&#44; behavioral interventions relieved eczema severity more effectively &#40;effect size &#91;95&#37; CI&#93;&#58; &#8722;0&#46;39 &#91;&#8722;0&#46;50&#44; &#8722;0&#46;28&#93;&#59; z&#8239;&#61;&#8239;&#8722;7&#46;003&#44; p&#8239;&#60;&#8239;0&#46;001&#41;&#46; The forest plot is depicted in <a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0095" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Itching intensity</span><p id="par0100" class="elsevierStylePara elsevierViewall">Among six included studies&#44; two studies<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">40&#44;44</span></a> involving three reports evaluated the effect of behavioral interventions on itching intensity&#46; All studies were considered homogeneous for this analysis &#40;I<span class="elsevierStyleSup">2</span> &#61; 0&#37;&#44; p&#8239;&#61;&#8239;0&#46;842&#41;&#46; Meta-analysis suggested behavioral interventions were comparable with traditional medical care in terms of itching intensity&#44; with a small effect size of &#8722;0&#46;02 &#40;95&#37; CI &#8722;0&#46;19 to 0&#46;16&#59; z &#61; &#8722;0&#46;202&#44; p&#8239;&#61;&#8239;0&#46;840&#41;&#46; The forest plot is depicted in <a class="elsevierStyleCrossRef" href="#fig0020">Fig&#46; 4</a>&#46;</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia></span><span id="sec0100" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Scratching severity</span><p id="par0105" class="elsevierStylePara elsevierViewall">Four studies involving five reports<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">40&#8211;42&#44;44</span></a> evaluated the effect of behavioral interventions on scratching severity&#46; Heterogeneity examination did not detect substantial statistical heterogeneity across studies for this analysis of scratching severity &#40;I<span class="elsevierStyleSup">2</span>&#8239;&#61;&#8239;34&#46;2&#37;&#44; p&#8239;&#61;&#8239;0&#46;194&#41;&#46; Results of the meta-analysis suggested that behavioral interventions were associated with decreased scratching severity compared with usual medical care&#44; with an effect size of -0&#46;19 &#40;95&#37; CI &#8722;0&#46;35 to &#8722;0&#46;03&#59; <span class="elsevierStyleItalic">z</span>&#8239;&#61;&#8239;&#8722;2&#46;377&#44; p&#8239;&#61;&#8239;0&#46;017&#41;&#46; The forest plot is depicted in <a class="elsevierStyleCrossRef" href="#fig0025">Fig&#46; 5</a>&#46;</p><elsevierMultimedia ident="fig0025"></elsevierMultimedia></span><span id="sec0105" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Subgroup analysis</span><p id="par0110" class="elsevierStylePara elsevierViewall">As introduced above&#44; two types of behavioral interventions were identified in this meta-analysis&#44; including habit-reversal behavioral therapy and cognitive-behavioral therapy&#46; We&#44; therefore&#44; conducted a subgroup analysis according to the types of interventions&#46; Results from subgroup analysis suggested that both habit-reversal behavioral therapy and cognitive-behavioral therapy effectively relieved eczema severity&#44; but only habit-reversal behavioral therapy significantly reduced scratching severity&#46; Detailed results of subgroup analyses are presented in Figure S1&#46;</p></span><span id="sec0110" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">Sensitivity analysis</span><p id="par0115" class="elsevierStylePara elsevierViewall">To analyze eczema severity&#44; the authors used the leave-one-out method to examine the robustness of the synthesized size of the effect&#46; As presented in Figure S2&#44; the synthesized size of the effect was not significantly changed after removing any one study at one time&#44; indicating the robustness and credibility of the synthesized effect size in the current study&#46;</p></span><span id="sec0115" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0155">Publication bias</span><p id="par0120" class="elsevierStylePara elsevierViewall">The publication bias of studies included for analysis of eczema severity was evaluated using Egger&#8217;s test and Begg&#8217;s test&#46; As shown in Figure S3&#44; a symmetrical funnel plot was generated for Egger&#8217;s test &#40;<span class="elsevierStyleItalic">z</span> &#61; &#8722;0&#46;15&#44; p&#8239;&#61;&#8239;0&#46;881&#41; and Begg&#8217;s test &#40;<span class="elsevierStyleItalic">t</span> &#61; &#8722;0&#46;19&#44; p&#8239;&#61;&#8239;0&#46;853&#41;&#44; suggesting the absence of publication bias&#46;</p></span></span></span><span id="sec0120" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0160">Discussion</span><p id="par0125" class="elsevierStylePara elsevierViewall">Although psychological interventions have been clinically recognized as effective&#44; their benefits for treating atopic dermatitis are still controversial&#46; This meta-analysis included 6 RCTs for data analysis&#46; Results suggest that behavioral interventions are more effective than usual medical care in relieving eczema and scratching severity&#46; Furthermore&#44; habit-reversal behavioral therapy is a more efficacious intervention for treating atopic dermatitis because separate analysis further demonstrates its benefits in relieving eczema and scratching severity&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Currently&#44; two published meta-analyses<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">19&#44;20</span></a> evaluated the effects of psychological and educational interventions on atopic dermatitis&#46; Chida et al&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> included eight studies in their meta-analysis&#44; and they identified eight types of intervention&#58; aromatherapy&#44; autogenic training&#44; brief dynamic psychotherapy&#44; cognitive-behavioral therapy&#44; dermatological education combined with cognitive-behavioral therapy&#44; habit reversal behavioral therapy&#44; stress management program&#44; and structured educational programs&#46; After calculating synthesized sizes of effect&#44; they found that the role of psychological interventions in treating atopic dermatitis was premature&#44; although it had a significant ameliorating effect on eczema severity&#44; itching intensity&#44; and scratching in atopic dermatitis patients&#46; In 2017&#44; Hashimoto et al&#46; conducted another meta-analysis to investigate the effect of psychological and educational interventions on atopic dermatitis&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> Pooled results from 3 RCTs suggested no significant difference in eczema severity between the two groups&#46; The effects of different psychological and educational interventions were different&#46;<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">21&#44;22</span></a> However&#44; previously published two meta-analyses just incorporated different types of interventions into an individual regimen&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">In this meta-analysis&#44; the authors specifically investigated the pure effects of behavioral interventions on health outcomes in atopic dermatitis patients compared with previous meta-analyses&#46; Meanwhile&#44; the authors evaluated the effects of habit-reversal behavioral therapy and cognitive-behavioral therapy in treating atopic dermatitis&#44; providing definitive evidence-based recommendations for clinical decision-making&#46; More importantly&#44; in this meta-analysis&#44; the authors evaluated the role of behavioral interventions in treating atopic dermatitis by calculating the magnitude of therapeutic effect based on the correlation coefficient&#46; Finally&#44; the authors evaluated statistical heterogeneity across studies for the individual outcome&#46; The authors calculated all synthesized sizes of effect with the random-effects model which simultaneously considered variations between studies and within studies&#46; Therefore&#44; the meta-analysis generated relatively conservative effect sizes&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">However&#44; the present meta-analysis remains to have some limitations&#46; First and foremost&#44; only six eligible studies with extremely insufficient sample sizes were included in this meta-analysis&#46; Therefore&#44; the current results should be cautiously interpreted due to inadequate statistical power&#46; Second&#44; patients enrolled in original studies were recruited from diverse backgrounds&#44; including clinic-based and population-based backgrounds&#44; which may introduce bias to the present findings&#46; Third&#44; five studies enrolled adult patients except for one study&#44; in which pediatric patients were included&#46; However&#44; the authors performed a sensitivity analysis to examine the robustness of synthesized effects using the leave-one-out method&#46; Sensitivity analysis indicated that behavioral interventions might be more effective for pediatric patients&#44; but the pooled result did not change statistically&#46; Fourth&#44; the authors did not conduct a subgroup analysis to eliminate the effect of variations in the duration of disease&#44; duration of treatment&#44; number of sessions&#44; duration of follow-up&#44; and outcome assessment method due to the insufficient number of eligible studies&#46; Fifth&#44; as stated in the subsection of the study design&#44; the authors did not register the used protocol in any public platform&#46; However&#44; the authors conducted this meta-analysis to ensure transparency and reliability in strict accordance with the Cochrane Handbook and PRISMA statements&#46; Sixth&#44; one study compared behavioral intervention combined with educational strategy to educational strategy alone&#59; however&#44; the authors also included it in the final analysis&#44; which may introduce bias for the pooled results due to variations in control&#46; Notably&#44; sensitivity analysis based on the leave-one-out strategy suggested that the inclusion of this study did not significantly affect the reliability of the pooled results&#46; Finally&#44; although the examination for the analysis of eczema severity did not show publication bias risk&#44; the authors must recognize that the cumulative number of eligible studies did not meet the minimum criteria of conducting a publication bias examination&#44; it is therefore difficult to eliminate the risk of obtaining false negative results&#46;</p></span><span id="sec0125" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0165">Conclusion</span><p id="par0145" class="elsevierStylePara elsevierViewall">In conclusion&#44; based on the currently available evidence&#44; the present meta-analysis indicates that behavioral interventions may be effective for relieving eczema severity and scratching severity&#46; In addition&#44; habit-reversal behavioral therapy may be more effective for the treatment of atopic dermatitis&#46; However&#44; the authors must recognize that the result for scratching severity is not accurate due to the small number of patients and the lower CI limits of almost null value&#46; More importantly&#44; the authors evaluated all outcomes only from a statistically significant perspective rather than from a clinical relevance&#46; Therefore&#44; the present findings should be further validated from a clinically relevant perspective in future studies&#46;</p></span><span id="sec0130" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0170">Financial support</span><p id="par0150" class="elsevierStylePara elsevierViewall">This paper was supported by The <span class="elsevierStyleGrantSponsor" id="gs0005">Hangzhou Biomedical and health industry development support special project Research Fund</span> &#40;<span class="elsevierStyleGrantNumber" refid="gs0005">2021WJCY294</span>&#41;&#46; The funding bodies had no role in the design of the study and collection&#44; analysis&#44; and interpretation of data and in writing the manuscript&#46;</p></span><span id="sec0135" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0175">Authors&#8217; contributions</span><p id="par0155" class="elsevierStylePara elsevierViewall">Wenying Zhong&#58; The study concept and design&#59; Writing of the manuscript or critical review of important intellectual content&#59; Data collection&#44; analysis&#44; and interpretation&#59; Effective participation in the research guidance&#59; Intellectual participation in the propaedeutic and&#47;or therapeutic conduct of the studied cases&#59; Critical review of the literature&#59; Final approval of the final version of the manuscript&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">Wei Li&#58; Data collection&#44; or analysis and interpretation of data&#59; statistical analysis&#59; Data collection&#44; analysis&#44; and interpretation&#59; Intellectual participation in the propaedeutic and&#47;or therapeutic conduct of the studied cases&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">Guangsheng Wu&#58; Data collection&#44; or analysis and interpretation of data&#59; Statistical analysis&#59; data collection&#44; analysis&#44; and interpretation&#59; Intellectual participation in the propaedeutic and&#47;or therapeutic conduct of the studied cases&#46;</p></span><span id="sec0140" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0180">Conflicts of interest</span><p id="par0170" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span></span>"
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              "titulo" => "Assessment of outcome"
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            6 => array:2 [
              "identificador" => "sec0055"
              "titulo" => "Risk of bias assessment"
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            7 => array:2 [
              "identificador" => "sec0060"
              "titulo" => "Statistical analysis"
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          ]
        ]
        4 => array:3 [
          "identificador" => "sec0065"
          "titulo" => "Results"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "sec0070"
              "titulo" => "Literature search"
            ]
            1 => array:2 [
              "identificador" => "sec0075"
              "titulo" => "Study characteristics"
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            2 => array:2 [
              "identificador" => "sec0080"
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            3 => array:3 [
              "identificador" => "sec0085"
              "titulo" => "Meta-analysis results"
              "secciones" => array:6 [
                0 => array:2 [
                  "identificador" => "sec0090"
                  "titulo" => "Eczema severity"
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                1 => array:2 [
                  "identificador" => "sec0095"
                  "titulo" => "Itching intensity"
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                2 => array:2 [
                  "identificador" => "sec0100"
                  "titulo" => "Scratching severity"
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                3 => array:2 [
                  "identificador" => "sec0105"
                  "titulo" => "Subgroup analysis"
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                4 => array:2 [
                  "identificador" => "sec0110"
                  "titulo" => "Sensitivity analysis"
                ]
                5 => array:2 [
                  "identificador" => "sec0115"
                  "titulo" => "Publication bias"
                ]
              ]
            ]
          ]
        ]
        5 => array:2 [
          "identificador" => "sec0120"
          "titulo" => "Discussion"
        ]
        6 => array:2 [
          "identificador" => "sec0125"
          "titulo" => "Conclusion"
        ]
        7 => array:2 [
          "identificador" => "sec0130"
          "titulo" => "Financial support"
        ]
        8 => array:2 [
          "identificador" => "sec0135"
          "titulo" => "Authors&#8217; contributions"
        ]
        9 => array:2 [
          "identificador" => "sec0140"
          "titulo" => "Conflicts of interest"
        ]
        10 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2023-06-03"
    "fechaAceptado" => "2023-09-21"
    "PalabrasClave" => array:1 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec1850932"
          "palabras" => array:4 [
            0 => "Behavioral therapy"
            1 => "Cognitive behavioral therapy"
            2 => "Dermatitis&#44; atopic"
            3 => "Meta-analysis"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:1 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">The treatment for atopic dermatitis &#40;AD&#41; has been the focus of clinical research&#44; and behavioral intervention is considered an indispensable treatment method&#46; To our knowledge&#44; no relevant meta-analysis has evaluated the effects of behavioral interventions on atopic dermatitis&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objectives</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">To evaluate the effects of behavioral interventions on atopic dermatitis&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Methods</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">The authors searched PubMed&#44; EMBASE&#44; and Cochrane CENTRAL to retrieve relevant RCTs &#40;up to Feb 2022&#41;&#46; The search strategy involved a combination of related keywords&#46; The Cochrane Q and I<span class="elsevierStyleSup">2</span> statistics were used to assess heterogeneity&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Results</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Six RCTs involving seven reports with 246 patients were included&#46; The results suggested that behavioral interventions could relieve eczema severity &#40;correlation coefficient &#91;<span class="elsevierStyleItalic">r</span> &#61; &#8722;0&#46;39&#93;&#59; p&#8239;&#60;&#8239;0&#46;001&#41; and scratching severity significantly &#40;<span class="elsevierStyleItalic">r</span> &#61; &#8722;0&#46;19&#59; p&#8239;&#61;&#8239;0&#46;017&#41;&#44; while not affect itching intensity &#40;<span class="elsevierStyleItalic">r</span> &#61; &#8722;0&#46;02&#59; p&#8239;&#61;&#8239;0&#46;840&#41;&#46; A sensitivity analysis confirmed the robustness of the results&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Study limitations</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">An important limitation of this study was the insufficient number of RCTs and the limited sample size&#46; In addition&#44; the study lacked a control group receiving a type of intervention other than the experimental protocol&#46; Another limitation was the short duration of follow-up&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conclusions</span><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">This study suggests that behavioral interventions could be effective in treating atopic dermatitis by reducing eczema and scratching severity&#46; Additionally&#44; habit-reversal behavioral therapy may be more effective for treating atopic dermatitis&#46;</p></span>"
        "secciones" => array:6 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Background"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Objectives"
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          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Methods"
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          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Results"
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          4 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Study limitations"
          ]
          5 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "Conclusions"
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        ]
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Study conducted at the Affiliated Hospital of Hangzhou Normal University&#44; Hangzhou&#44; Zhejiang&#44; China&#46;</p>"
      ]
    ]
    "apendice" => array:1 [
      0 => array:1 [
        "seccion" => array:1 [
          0 => array:4 [
            "apendice" => "<p id="par0180" class="elsevierStylePara elsevierViewall">The following is Supplementary data to this article&#58;<elsevierMultimedia ident="upi0005"></elsevierMultimedia></p>"
            "etiqueta" => "Appendix A"
            "titulo" => "Supplementary material"
            "identificador" => "sec0150"
          ]
        ]
      ]
    ]
    "multimedia" => array:8 [
      0 => array:8 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 2548
            "Ancho" => 2508
            "Tamanyo" => 436898
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        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0005"
            "detalle" => "Figure "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Flow chart of the process of selecting study&#46;</p>"
        ]
      ]
      1 => array:8 [
        "identificador" => "fig0010"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 1173
            "Ancho" => 1675
            "Tamanyo" => 214795
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        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0010"
            "detalle" => "Figure "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Risk of bias assessment of included studies&#46; In this figure&#44; Q1 to Q7 represents random sequence generation&#44; allocation concealment&#44; blinding of participants and personnel&#44; blinding of outcome assessment&#44; incomplete outcome data&#44; selective reporting outcome&#44; and other bias&#44; respectively&#46;</p>"
        ]
      ]
      2 => array:8 [
        "identificador" => "fig0015"
        "etiqueta" => "Figure 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr3.jpeg"
            "Alto" => 1632
            "Ancho" => 2925
            "Tamanyo" => 253476
          ]
        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0015"
            "detalle" => "Figure "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Meta-analysis of effect size of psychological interventions for relieving eczema severity&#46; CI&#44; Confidence Interval&#46;</p>"
        ]
      ]
      3 => array:8 [
        "identificador" => "fig0020"
        "etiqueta" => "Figure 4"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr4.jpeg"
            "Alto" => 1255
            "Ancho" => 2925
            "Tamanyo" => 140312
          ]
        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0020"
            "detalle" => "Figure "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Meta-analysis of effect size of psychological interventions for reducing itching intensity&#46; CI&#44; Confidence Interval&#46;</p>"
        ]
      ]
      4 => array:8 [
        "identificador" => "fig0025"
        "etiqueta" => "Figure 5"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr5.jpeg"
            "Alto" => 1490
            "Ancho" => 2925
            "Tamanyo" => 183650
          ]
        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0025"
            "detalle" => "Figure "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Meta-analysis of effect size of psychological interventions for reducing scratching severity&#46; CI&#44; Confidence Interval&#46;</p>"
        ]
      ]
      5 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
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        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0030"
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          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">UMC&#44; Usual Medical Care&#59; DE&#44; Dermatological Education&#59; BT&#44; Behavioral Therapy&#59; ADAM&#44; Atopic Dermatitis Assessment Measure&#59; SCORAD&#44; Scoring Atopic Dermatitis&#59; N&#46;R&#46;&#44; Not Reported&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Study&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Country&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Setting&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Design&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Sample size&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mean age&#44; years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Percent female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Duration of disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Duration of treatment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Number of sessions&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Follow-up&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Outcome assessment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " rowspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ehlers&#44; et al&#46;&#44; 1995</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Germany</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Clinic-based</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">UMC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">68&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12 weeks</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 weeks</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Physician&#8217;s evaluation</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">DE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">60&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">BT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">57&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">DE&#8239;&#43;&#8239;BT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">62&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Habib&#44; et al&#46;&#44; 1999</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Australia</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Population-based</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">UMC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">33&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">87&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 weeks</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14 weeks</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ADAM</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">BT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">36&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">78&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Melin&#44; et al&#46;&#44; 1986</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sweden</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Clinic-based</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">UMC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30&#46;5</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">n&#46;r&#46;</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#46;R&#46;</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 weeks</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 weeks</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Physician&#8217;s evaluation</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">BT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Noren&#44; et al&#46;&#44; 1989</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sweden</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Clinic-based</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">UMC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24&#46;8</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">64&#37;</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#46;R&#46;</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 weeks</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 weeks</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Physician&#8217;s evaluation</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">BT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Schut&#44; et al&#46;&#44; 2013</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Germany</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Population-based</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">UMC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">71&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#46;R&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 weeks</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 weeks</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">SCORAD</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">BT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">71&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#46;R&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Noren&#44; et al&#46;&#44; 2018</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sweden</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Population-based</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">UMC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">72&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 weeks</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 weeks</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">SCORAD</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">BT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">62&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#8722;0&#46;499 &#40;&#8722;0&#46;790 to &#8722;0&#46;024&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">N&#46;R&#46;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#8722;0&#46;426 &#40;&#8722;0&#46;761 to 0&#46;088&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0 &#40;&#8722;0&#46;496 to 0&#46;496&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#8722;0&#46;574 &#40;&#8722;0&#46;833 to &#8722;0&#46;109&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Noren&#44; et al&#46;&#44; 1989&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#8722;0&#46;346 &#40;&#8722;0&#46;581 to &#8722;0&#46;058&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">N&#46;R&#46;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Schut&#44; et al&#46;&#44; 2013&nbsp;\t\t\t\t\t\t\n
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Original Article
Are behavioral interventions a better choice for atopic dermatitis patients? A meta-analysis of 6 randomized controlled trials
Wenying Zhonga,
Autor para correspondência
sczjhzzwy@126.com

Corresponding author.
, Wei Lia, Guangsheng Wub
a Department of Dermatology, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China
b Department of Pediatrics, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China
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ethnicity&#44; and lifestyle factors of patients&#44; the etiology of atopic dermatitis has not been fully clarified&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#8211;9</span></a> Currently&#44; topical application of emollients and anti-inflammation agents is still the basic strategy for treating atopic dermatitis&#46;<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">10&#44;11</span></a> The topical therapy is not effective for the treatment among a considerable proportion of moderate-to-severe patients&#44;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> which may cause a series of psychological consequences&#44; such as sleep disturbance&#44; anxiety&#44; depression&#44; and financial strain&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> Meanwhile&#44; psychological factors have also been shown to aggravate skin symptoms&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> Therefore&#44; psychological interventions are considered an indispensable element of multidisciplinary management strategy for atopic dermatitis&#46;<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">14&#44;15</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Up to now&#44; several original studies<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">16&#8211;18</span></a> have investigated the therapeutic effects of various psychological intervention strategies on atopic dermatitis&#46; Meanwhile&#44; some meta-analyses<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">19&#44;20</span></a> have also systematically evaluated the role of psychological and educational interventions in treating atopic dermatitis&#46; However&#44; the results of previously published studies of psychological interventions for atopic dermatitis are conflicting&#46; It&#8217;s noted that the therapeutic effects of psychological interventions may change according to the variations of types of psychological interventions&#46;<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">21&#44;22</span></a> However&#44; different psychological interventions were combined as an individual interventional strategy in the previous meta-analyses&#44;<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">19&#44;20</span></a> which may cause conflicting findings&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">As an indispensable part of psychological interventions&#44; behavioral therapy refers to the application of modern theories of learning and conditioning in the treatment of behavior disorders&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a> Currently&#44; many behavioral techniques have been used in clinical practice&#44; such as cognitive behavioral therapy&#44; habit-reversal therapy&#44; and dialectical behavior therapy&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a> Of these available behavioral techniques&#44; habit-reversal therapy<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a> and cognitive behavioral therapy<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">25&#44;26</span></a> have been used successfully in dermatology&#46; Habit-reversal therapy was initially described by Azrin and Nunn as a competing response produced by tightening muscles with antagonists&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a> Habit-reversal therapy consists of multiple components&#44; but competing response training and awareness training represent its most effective techniques&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a> While&#44; cognitive behavioral therapy is a combination of cognitive and behavioral approaches&#44; which can help the patient recognize his distorted thoughts and ineffective behaviors&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Several studies<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">24&#44;26</span></a> have explored the potential of habit-reversal therapy and cognitive behavioral therapy in managing atopic dermatitis&#46; Bewley has reported that atopic dermatitis patients who received three weeks of habit-reversal therapy had significantly better atopic dermatitis scores than those of the topical treatments alone&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a> Goyonlo et al&#46; suggested that cognitive behavioral therapy helped dermatitis patients improve clinical severity scores&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a> To our knowledge&#44; there has been no relevant meta-analysis evaluating the effects of behavioral interventions on atopic dermatitis&#46; Therefore&#44; the authors conducted the present meta-analysis to assess the effects of separate behavioral interventions on health outcomes in atopic dermatitis patients&#46; The authors aimed to provide a definitive evidence-based recommendation for behavioral interventions in atopic dermatitis patients&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Study design</span><p id="par0030" class="elsevierStylePara elsevierViewall">This systematic review and meta-analysis was carried out following the structure recommended by the Cochrane Handbook&#44;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a> and was reported in strict accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis &#40;PRISMA&#41; checklist&#44;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">31</span></a> thus strongly ensuring the transparency and reliability of conducting the current meta-analysis&#46; All these fulfill the requirement of registering a formal protocol in a public platform&#44; therefore the authors did not further register a protocol for this meta-analysis&#46; This study did not require ethical approval and the patient&#8217;s informed consent&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Selection criteria</span><p id="par0035" class="elsevierStylePara elsevierViewall">Two independent reviewers strictly followed the criteria to select studies from the retrieved records&#46; When there was disagreement about the literature retrieval&#44; the authors resolved it by consulting a third reviewer&#46; Three steps were designed for study selection&#58; &#40;a&#41; Removal of duplicate studies based on EndNote software&#59; &#40;b&#41; Initial eligibility assessment based on the titles and abstracts screening&#59; and &#40;c&#41; Final eligibility assessment based on full-text evaluation&#46;</p><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Inclusion criteria</span><p id="par0040" class="elsevierStylePara elsevierViewall">Eligibility of each study was evaluated using the PICOS acronym&#44; including patients&#44; intervention&#44; comparison&#44; outcome&#44; and study design&#58; &#40;a&#41; Patients were diagnosed with atopic dermatitis by a physician with recognized criteria &#40;<span class="elsevierStyleItalic">P acronym</span>&#41;&#59; &#40;b&#41; Patients in the experimental group were instructed to receive behavioral interventions in addition to usual medical care for atopic dermatitis &#40;<span class="elsevierStyleItalic">I acronym</span>&#41;&#59; &#40;c&#41; Patients in the control group received usual medical care alone &#40;<span class="elsevierStyleItalic">C acronym</span>&#41;&#59; &#40;d&#41; At least one of eczema severity&#44; itching intensity&#44; and scratching severity was reported effectively &#40;<span class="elsevierStyleItalic">O acronym</span>&#41;&#59; and &#40;e&#41; Patients were randomly assigned into different groups &#40;<span class="elsevierStyleItalic">S acronym</span>&#41;&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Exclusion criteria</span><p id="par0045" class="elsevierStylePara elsevierViewall">Studies were excluded from the following criteria&#58; &#40;a&#41; Behavioral interventions were designed as one part of the psychological protocol rather than separate intervention&#59; &#40;b&#41; Data about correlation coefficient &#40;<span class="elsevierStyleItalic">r</span>&#41; were not available&#59; &#40;c&#41; Ineligible study design was used&#44; such as quasi-randomized studies&#44; observational studies&#44; and animal studies&#59; and &#40;d&#41; Duplicate studies with overlapped samples&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Information sources</span><p id="par0050" class="elsevierStylePara elsevierViewall">The authors systematically searched three common English databases&#44; including PubMed&#44; EMBASE&#44; and the Cochrane Central Registry for Controlled Trials &#40;CENTRAL&#41;&#44; for retrieving relevant Randomized Controlled Trials &#40;RCT&#41; regarding the application of behavioral interventions in atopic dermatitis patients from their inception until February 2022&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Search strategy</span><p id="par0055" class="elsevierStylePara elsevierViewall">The search strategy was developed using subject terms and free words as follows&#58; &#8220;atopic dermatitis&#8221;&#44; &#8220;habit-reversal&#8221;&#44; &#8220;behavior therapy&#8221;&#44; &#8220;behavior modification&#8221;&#44; &#8220;behavior change&#8221;&#44; and &#8220;behavior treatment&#8221;&#46; Two independent reviewers conducted the search and updated weekly to avoid missing potentially eligible studies&#46; The authors also identified additional relevant studies through screening references of included studies and topic-related meta-analysis&#46; The authors did not restrict the publication status in literature retrieval&#46; Detailed search strategies of target databases were reported in Table S1&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Data extraction</span><p id="par0060" class="elsevierStylePara elsevierViewall">Two independent reviewers extracted the essential information from eligible studies using a pre-designed standard sheet&#46; The following information was extracted&#58; authors&#44; year of publication&#44; country&#44; sample size&#44; percentage of female patients&#44; the mean age of patients&#44; duration of atopic dermatitis&#44; details of grouping&#44; duration of intervention&#44; the number of sessions&#44; follow-up duration&#44; detailed outcomes of interest&#44; and information for quality assessment&#46; The authors also contacted authors to obtain more information if necessary&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Assessment of outcome</span><p id="par0065" class="elsevierStylePara elsevierViewall">This meta-analysis evaluated three outcomes&#44; including eczema severity&#44; itching intensity&#44; and scratching severity&#46; Eczema severity was measured using the Scoring the Severity of Atopic Dermatitis &#40;SCORAD&#41;&#44; the Modified SCORAD&#44; the AD Assessment Measure &#40;ADAM&#41;&#44; or the authors&#8217; original scoring methods&#44; and itching and scratching intensity was measured using a subjective Likert-type scale&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Risk of bias assessment</span><p id="par0070" class="elsevierStylePara elsevierViewall">Quality assessment was conducted by two independent reviewers using the Cochrane risk of bias assessment tool&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">32</span></a> In this assessment tool&#44; seven items were involved&#44; including random sequence generation &#40;selection bias&#41;&#44; allocation concealment &#40;selection bias&#41;&#44; blinding of participants and personnel &#40;performance bias&#41;&#44; blinding of outcome assessment &#40;detection bias&#41;&#44; incomplete outcome data &#40;attrition bias&#41;&#44; selective reporting bias &#40;reporting bias&#41;&#44; and other bias&#46; Each item would be classified as &#8220;low&#8221;&#44; &#8220;unclear&#8221;&#44; or &#8220;high&#8221; risk based on the actual information reported in studies&#46; Finally&#44; the overall quality of each study was appraised as either &#8220;low&#8221;&#44; &#8220;moderate&#8221;&#44; or &#8220;high&#8221; level&#46; Specifically&#44; the overall methodological quality was appraised as &#8220;high&#8221; if all items were classified as &#8220;low&#8221; risk&#44; &#8220;low&#8221; if at least one of the seven items was classified as &#8220;high&#8221; risk&#44; or &#8220;moderate&#8221; if at least one of the seven items was classified as &#8220;unclear&#8221; risk but no one was classified as &#8220;high&#8221; risk&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Statistical analysis</span><p id="par0075" class="elsevierStylePara elsevierViewall">In this meta-analysis&#44; the authors used Stata 14&#46;0 software &#40;State Corporation&#44; Lake Way&#44; Texas&#44; USA&#41; to calculate the effect size&#44; which was expressed as a correlation coefficient &#40;<span class="elsevierStyleItalic">r</span>&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">33</span></a> Statistical heterogeneity across studies was tested using Cochrane <span class="elsevierStyleItalic">Q</span><a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">34&#44;35</span></a> and I<span class="elsevierStyleSup">2</span> statistic&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">36</span></a> Studies were considered homogeneous if p&#8239;&#62;&#8239;0&#46;1 and I<span class="elsevierStyleSup">2</span> &#60; 50&#37;&#59; Otherwise&#44; they were regarded as heterogeneous&#46; The authors selected the random-effects model for all statistical analyses regardless of the level of statistical heterogeneity because this model incorporated the variance resulting from differences between studies and within studies into estimates calculation&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">35</span></a> The authors calculated the corresponding <span class="elsevierStyleItalic">r</span> value according to the data reported in the included studies using an online calculator&#44; namely the &#8220;Practical Meta-Analysis Effect Size Calculator&#8221;&#44; which was designed by Wilson et al&#46; to facilitate the computation of effect sizes for meta-analysis&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">37</span></a> The authors performed a sensitivity analysis to examine the robustness of results for eczema severity through the leave-one-out method&#46; Finally&#44; publication bias examination for meta-analysis of eczema severity was conducted using the Egger linear regression and Begg rank relationship methods although the cumulative number of eligible studies does not exceed 10&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">38</span></a></p></span></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Results</span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Literature search</span><p id="par0080" class="elsevierStylePara elsevierViewall">The authors retrieved 237 records from electronic databases using pre-designed search strategies&#46; After removing 36 duplicate records&#44; 201 unique studies were retained for initial eligibility evaluation&#46; The authors excluded a total of 194 ineligible studies after screening the titles and abstracts due to being unrelated to the topic &#40;n&#8239;&#61;&#8239;183&#41;&#44; registered study protocol &#40;n&#8239;&#61;&#8239;8&#41;&#44; and meta-analysis &#40;n&#8239;&#61;&#8239;3&#41;&#46; Then&#44; the authors retrieved the full texts of the remaining seven studies for further eligibility evaluation&#46; After excluding two ineligible studies due to ineligible topics&#44; five studies<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">39&#8211;43</span></a> were considered for meeting the selection criteria&#46; Moreover&#44; the authors identified another eligible study<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">44</span></a> from a previous meta-analysis&#46; Finally&#44; six RCTs<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">39&#8211;44</span></a> involving seven reports were included in this meta-analysis because the study by Ehlers et al&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">44</span></a> compared the effectiveness of 4 group treatments for atopic dermatitis&#46; The detailed process of selecting the study is indicated in <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Study characteristics</span><p id="par0085" class="elsevierStylePara elsevierViewall">Detailed basic characteristics of the included studies are presented in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; A total of 246 patients were included in the current study&#46;<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">39&#8211;44</span></a> Five studies<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">39&#8211;44</span></a> enrolled adult patients&#44; and pediatric patients were included in only one study&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">40</span></a> Among six included studies&#44; three studies<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">40&#8211;42</span></a> designed habit reversal behavioral therapy&#44; and another three<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">39&#44;43&#44;44</span></a> designed cognitive behavioral therapy for treating atopic dermatitis&#46; Three studies<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">40&#44;42&#44;44</span></a> assigned physician to evaluate outcomes&#59; two studies<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">41&#44;43</span></a> measured outcomes with the Scoring Atopic Dermatitis &#40;SCORAD&#41;&#59; and one study<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">39</span></a> used Atopic Dermatitis Assessment Measure &#40;ADAM&#41; to evaluate outcomes&#46; The effect sizes of included studies regarding target outcomes of interest are presented in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Risk of bias</span><p id="par0090" class="elsevierStylePara elsevierViewall">Only one study <a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">41</span></a> specifically introduced the method of generating random sequences and performing allocation&#46; All studies <a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">39&#8211;44</span></a> were rated as having an unclear risk for blinding participants and personnel&#44; and one study <a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">44</span></a> was rated as high risk for blinding of outcome assessment&#46; All studies <a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">39&#8211;44</span></a> were rated as low risk for attrition bias and reporting bias but high risk for other biases due to extremely insufficient sample size&#46; Detailed results of the quality assessment are presented in <a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Meta-analysis results</span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Eczema severity</span><p id="par0095" class="elsevierStylePara elsevierViewall">All included studies&#44;<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">39&#8211;44</span></a> involving seven reports with 246 patients&#44; evaluated the effect of behavioral interventions on eczema severity&#46; Heterogeneity examination indicated that all studies were homogeneous for analysis of eczema severity &#40;I<span class="elsevierStyleSup">2</span>&#8239;&#61;&#8239;0&#37;&#44; p&#8239;&#61;&#8239;0&#46;890&#41;&#46; Meta-analysis indicated that&#44; compared to traditional medical care&#44; behavioral interventions relieved eczema severity more effectively &#40;effect size &#91;95&#37; CI&#93;&#58; &#8722;0&#46;39 &#91;&#8722;0&#46;50&#44; &#8722;0&#46;28&#93;&#59; z&#8239;&#61;&#8239;&#8722;7&#46;003&#44; p&#8239;&#60;&#8239;0&#46;001&#41;&#46; The forest plot is depicted in <a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0095" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Itching intensity</span><p id="par0100" class="elsevierStylePara elsevierViewall">Among six included studies&#44; two studies<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">40&#44;44</span></a> involving three reports evaluated the effect of behavioral interventions on itching intensity&#46; All studies were considered homogeneous for this analysis &#40;I<span class="elsevierStyleSup">2</span> &#61; 0&#37;&#44; p&#8239;&#61;&#8239;0&#46;842&#41;&#46; Meta-analysis suggested behavioral interventions were comparable with traditional medical care in terms of itching intensity&#44; with a small effect size of &#8722;0&#46;02 &#40;95&#37; CI &#8722;0&#46;19 to 0&#46;16&#59; z &#61; &#8722;0&#46;202&#44; p&#8239;&#61;&#8239;0&#46;840&#41;&#46; The forest plot is depicted in <a class="elsevierStyleCrossRef" href="#fig0020">Fig&#46; 4</a>&#46;</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia></span><span id="sec0100" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Scratching severity</span><p id="par0105" class="elsevierStylePara elsevierViewall">Four studies involving five reports<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">40&#8211;42&#44;44</span></a> evaluated the effect of behavioral interventions on scratching severity&#46; Heterogeneity examination did not detect substantial statistical heterogeneity across studies for this analysis of scratching severity &#40;I<span class="elsevierStyleSup">2</span>&#8239;&#61;&#8239;34&#46;2&#37;&#44; p&#8239;&#61;&#8239;0&#46;194&#41;&#46; Results of the meta-analysis suggested that behavioral interventions were associated with decreased scratching severity compared with usual medical care&#44; with an effect size of -0&#46;19 &#40;95&#37; CI &#8722;0&#46;35 to &#8722;0&#46;03&#59; <span class="elsevierStyleItalic">z</span>&#8239;&#61;&#8239;&#8722;2&#46;377&#44; p&#8239;&#61;&#8239;0&#46;017&#41;&#46; The forest plot is depicted in <a class="elsevierStyleCrossRef" href="#fig0025">Fig&#46; 5</a>&#46;</p><elsevierMultimedia ident="fig0025"></elsevierMultimedia></span><span id="sec0105" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Subgroup analysis</span><p id="par0110" class="elsevierStylePara elsevierViewall">As introduced above&#44; two types of behavioral interventions were identified in this meta-analysis&#44; including habit-reversal behavioral therapy and cognitive-behavioral therapy&#46; We&#44; therefore&#44; conducted a subgroup analysis according to the types of interventions&#46; Results from subgroup analysis suggested that both habit-reversal behavioral therapy and cognitive-behavioral therapy effectively relieved eczema severity&#44; but only habit-reversal behavioral therapy significantly reduced scratching severity&#46; Detailed results of subgroup analyses are presented in Figure S1&#46;</p></span><span id="sec0110" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">Sensitivity analysis</span><p id="par0115" class="elsevierStylePara elsevierViewall">To analyze eczema severity&#44; the authors used the leave-one-out method to examine the robustness of the synthesized size of the effect&#46; As presented in Figure S2&#44; the synthesized size of the effect was not significantly changed after removing any one study at one time&#44; indicating the robustness and credibility of the synthesized effect size in the current study&#46;</p></span><span id="sec0115" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0155">Publication bias</span><p id="par0120" class="elsevierStylePara elsevierViewall">The publication bias of studies included for analysis of eczema severity was evaluated using Egger&#8217;s test and Begg&#8217;s test&#46; As shown in Figure S3&#44; a symmetrical funnel plot was generated for Egger&#8217;s test &#40;<span class="elsevierStyleItalic">z</span> &#61; &#8722;0&#46;15&#44; p&#8239;&#61;&#8239;0&#46;881&#41; and Begg&#8217;s test &#40;<span class="elsevierStyleItalic">t</span> &#61; &#8722;0&#46;19&#44; p&#8239;&#61;&#8239;0&#46;853&#41;&#44; suggesting the absence of publication bias&#46;</p></span></span></span><span id="sec0120" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0160">Discussion</span><p id="par0125" class="elsevierStylePara elsevierViewall">Although psychological interventions have been clinically recognized as effective&#44; their benefits for treating atopic dermatitis are still controversial&#46; This meta-analysis included 6 RCTs for data analysis&#46; Results suggest that behavioral interventions are more effective than usual medical care in relieving eczema and scratching severity&#46; Furthermore&#44; habit-reversal behavioral therapy is a more efficacious intervention for treating atopic dermatitis because separate analysis further demonstrates its benefits in relieving eczema and scratching severity&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Currently&#44; two published meta-analyses<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">19&#44;20</span></a> evaluated the effects of psychological and educational interventions on atopic dermatitis&#46; Chida et al&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> included eight studies in their meta-analysis&#44; and they identified eight types of intervention&#58; aromatherapy&#44; autogenic training&#44; brief dynamic psychotherapy&#44; cognitive-behavioral therapy&#44; dermatological education combined with cognitive-behavioral therapy&#44; habit reversal behavioral therapy&#44; stress management program&#44; and structured educational programs&#46; After calculating synthesized sizes of effect&#44; they found that the role of psychological interventions in treating atopic dermatitis was premature&#44; although it had a significant ameliorating effect on eczema severity&#44; itching intensity&#44; and scratching in atopic dermatitis patients&#46; In 2017&#44; Hashimoto et al&#46; conducted another meta-analysis to investigate the effect of psychological and educational interventions on atopic dermatitis&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> Pooled results from 3 RCTs suggested no significant difference in eczema severity between the two groups&#46; The effects of different psychological and educational interventions were different&#46;<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">21&#44;22</span></a> However&#44; previously published two meta-analyses just incorporated different types of interventions into an individual regimen&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">In this meta-analysis&#44; the authors specifically investigated the pure effects of behavioral interventions on health outcomes in atopic dermatitis patients compared with previous meta-analyses&#46; Meanwhile&#44; the authors evaluated the effects of habit-reversal behavioral therapy and cognitive-behavioral therapy in treating atopic dermatitis&#44; providing definitive evidence-based recommendations for clinical decision-making&#46; More importantly&#44; in this meta-analysis&#44; the authors evaluated the role of behavioral interventions in treating atopic dermatitis by calculating the magnitude of therapeutic effect based on the correlation coefficient&#46; Finally&#44; the authors evaluated statistical heterogeneity across studies for the individual outcome&#46; The authors calculated all synthesized sizes of effect with the random-effects model which simultaneously considered variations between studies and within studies&#46; Therefore&#44; the meta-analysis generated relatively conservative effect sizes&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">However&#44; the present meta-analysis remains to have some limitations&#46; First and foremost&#44; only six eligible studies with extremely insufficient sample sizes were included in this meta-analysis&#46; Therefore&#44; the current results should be cautiously interpreted due to inadequate statistical power&#46; Second&#44; patients enrolled in original studies were recruited from diverse backgrounds&#44; including clinic-based and population-based backgrounds&#44; which may introduce bias to the present findings&#46; Third&#44; five studies enrolled adult patients except for one study&#44; in which pediatric patients were included&#46; However&#44; the authors performed a sensitivity analysis to examine the robustness of synthesized effects using the leave-one-out method&#46; Sensitivity analysis indicated that behavioral interventions might be more effective for pediatric patients&#44; but the pooled result did not change statistically&#46; Fourth&#44; the authors did not conduct a subgroup analysis to eliminate the effect of variations in the duration of disease&#44; duration of treatment&#44; number of sessions&#44; duration of follow-up&#44; and outcome assessment method due to the insufficient number of eligible studies&#46; Fifth&#44; as stated in the subsection of the study design&#44; the authors did not register the used protocol in any public platform&#46; However&#44; the authors conducted this meta-analysis to ensure transparency and reliability in strict accordance with the Cochrane Handbook and PRISMA statements&#46; Sixth&#44; one study compared behavioral intervention combined with educational strategy to educational strategy alone&#59; however&#44; the authors also included it in the final analysis&#44; which may introduce bias for the pooled results due to variations in control&#46; Notably&#44; sensitivity analysis based on the leave-one-out strategy suggested that the inclusion of this study did not significantly affect the reliability of the pooled results&#46; Finally&#44; although the examination for the analysis of eczema severity did not show publication bias risk&#44; the authors must recognize that the cumulative number of eligible studies did not meet the minimum criteria of conducting a publication bias examination&#44; it is therefore difficult to eliminate the risk of obtaining false negative results&#46;</p></span><span id="sec0125" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0165">Conclusion</span><p id="par0145" class="elsevierStylePara elsevierViewall">In conclusion&#44; based on the currently available evidence&#44; the present meta-analysis indicates that behavioral interventions may be effective for relieving eczema severity and scratching severity&#46; In addition&#44; habit-reversal behavioral therapy may be more effective for the treatment of atopic dermatitis&#46; However&#44; the authors must recognize that the result for scratching severity is not accurate due to the small number of patients and the lower CI limits of almost null value&#46; More importantly&#44; the authors evaluated all outcomes only from a statistically significant perspective rather than from a clinical relevance&#46; Therefore&#44; the present findings should be further validated from a clinically relevant perspective in future studies&#46;</p></span><span id="sec0130" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0170">Financial support</span><p id="par0150" class="elsevierStylePara elsevierViewall">This paper was supported by The <span class="elsevierStyleGrantSponsor" id="gs0005">Hangzhou Biomedical and health industry development support special project Research Fund</span> &#40;<span class="elsevierStyleGrantNumber" refid="gs0005">2021WJCY294</span>&#41;&#46; The funding bodies had no role in the design of the study and collection&#44; analysis&#44; and interpretation of data and in writing the manuscript&#46;</p></span><span id="sec0135" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0175">Authors&#8217; contributions</span><p id="par0155" class="elsevierStylePara elsevierViewall">Wenying Zhong&#58; The study concept and design&#59; Writing of the manuscript or critical review of important intellectual content&#59; Data collection&#44; analysis&#44; and interpretation&#59; Effective participation in the research guidance&#59; Intellectual participation in the propaedeutic and&#47;or therapeutic conduct of the studied cases&#59; Critical review of the literature&#59; Final approval of the final version of the manuscript&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">Wei Li&#58; Data collection&#44; or analysis and interpretation of data&#59; statistical analysis&#59; Data collection&#44; analysis&#44; and interpretation&#59; Intellectual participation in the propaedeutic and&#47;or therapeutic conduct of the studied cases&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">Guangsheng Wu&#58; Data collection&#44; or analysis and interpretation of data&#59; Statistical analysis&#59; data collection&#44; analysis&#44; and interpretation&#59; Intellectual participation in the propaedeutic and&#47;or therapeutic conduct of the studied cases&#46;</p></span><span id="sec0140" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0180">Conflicts of interest</span><p id="par0170" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span></span>"
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              "titulo" => "Objectives"
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            2 => array:2 [
              "identificador" => "abst0015"
              "titulo" => "Methods"
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            3 => array:2 [
              "identificador" => "abst0020"
              "titulo" => "Results"
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            4 => array:2 [
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              "titulo" => "Study limitations"
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            5 => array:2 [
              "identificador" => "abst0030"
              "titulo" => "Conclusions"
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          ]
        ]
        1 => array:2 [
          "identificador" => "xpalclavsec1850932"
          "titulo" => "Keywords"
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        2 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introduction"
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        3 => array:3 [
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          "titulo" => "Methods"
          "secciones" => array:8 [
            0 => array:2 [
              "identificador" => "sec0015"
              "titulo" => "Study design"
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            1 => array:3 [
              "identificador" => "sec0020"
              "titulo" => "Selection criteria"
              "secciones" => array:2 [
                0 => array:2 [
                  "identificador" => "sec0025"
                  "titulo" => "Inclusion criteria"
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                1 => array:2 [
                  "identificador" => "sec0030"
                  "titulo" => "Exclusion criteria"
                ]
              ]
            ]
            2 => array:2 [
              "identificador" => "sec0035"
              "titulo" => "Information sources"
            ]
            3 => array:2 [
              "identificador" => "sec0040"
              "titulo" => "Search strategy"
            ]
            4 => array:2 [
              "identificador" => "sec0045"
              "titulo" => "Data extraction"
            ]
            5 => array:2 [
              "identificador" => "sec0050"
              "titulo" => "Assessment of outcome"
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            6 => array:2 [
              "identificador" => "sec0055"
              "titulo" => "Risk of bias assessment"
            ]
            7 => array:2 [
              "identificador" => "sec0060"
              "titulo" => "Statistical analysis"
            ]
          ]
        ]
        4 => array:3 [
          "identificador" => "sec0065"
          "titulo" => "Results"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "sec0070"
              "titulo" => "Literature search"
            ]
            1 => array:2 [
              "identificador" => "sec0075"
              "titulo" => "Study characteristics"
            ]
            2 => array:2 [
              "identificador" => "sec0080"
              "titulo" => "Risk of bias"
            ]
            3 => array:3 [
              "identificador" => "sec0085"
              "titulo" => "Meta-analysis results"
              "secciones" => array:6 [
                0 => array:2 [
                  "identificador" => "sec0090"
                  "titulo" => "Eczema severity"
                ]
                1 => array:2 [
                  "identificador" => "sec0095"
                  "titulo" => "Itching intensity"
                ]
                2 => array:2 [
                  "identificador" => "sec0100"
                  "titulo" => "Scratching severity"
                ]
                3 => array:2 [
                  "identificador" => "sec0105"
                  "titulo" => "Subgroup analysis"
                ]
                4 => array:2 [
                  "identificador" => "sec0110"
                  "titulo" => "Sensitivity analysis"
                ]
                5 => array:2 [
                  "identificador" => "sec0115"
                  "titulo" => "Publication bias"
                ]
              ]
            ]
          ]
        ]
        5 => array:2 [
          "identificador" => "sec0120"
          "titulo" => "Discussion"
        ]
        6 => array:2 [
          "identificador" => "sec0125"
          "titulo" => "Conclusion"
        ]
        7 => array:2 [
          "identificador" => "sec0130"
          "titulo" => "Financial support"
        ]
        8 => array:2 [
          "identificador" => "sec0135"
          "titulo" => "Authors&#8217; contributions"
        ]
        9 => array:2 [
          "identificador" => "sec0140"
          "titulo" => "Conflicts of interest"
        ]
        10 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2023-06-03"
    "fechaAceptado" => "2023-09-21"
    "PalabrasClave" => array:1 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec1850932"
          "palabras" => array:4 [
            0 => "Behavioral therapy"
            1 => "Cognitive behavioral therapy"
            2 => "Dermatitis&#44; atopic"
            3 => "Meta-analysis"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:1 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">The treatment for atopic dermatitis &#40;AD&#41; has been the focus of clinical research&#44; and behavioral intervention is considered an indispensable treatment method&#46; To our knowledge&#44; no relevant meta-analysis has evaluated the effects of behavioral interventions on atopic dermatitis&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objectives</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">To evaluate the effects of behavioral interventions on atopic dermatitis&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Methods</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">The authors searched PubMed&#44; EMBASE&#44; and Cochrane CENTRAL to retrieve relevant RCTs &#40;up to Feb 2022&#41;&#46; The search strategy involved a combination of related keywords&#46; The Cochrane Q and I<span class="elsevierStyleSup">2</span> statistics were used to assess heterogeneity&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Results</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Six RCTs involving seven reports with 246 patients were included&#46; The results suggested that behavioral interventions could relieve eczema severity &#40;correlation coefficient &#91;<span class="elsevierStyleItalic">r</span> &#61; &#8722;0&#46;39&#93;&#59; p&#8239;&#60;&#8239;0&#46;001&#41; and scratching severity significantly &#40;<span class="elsevierStyleItalic">r</span> &#61; &#8722;0&#46;19&#59; p&#8239;&#61;&#8239;0&#46;017&#41;&#44; while not affect itching intensity &#40;<span class="elsevierStyleItalic">r</span> &#61; &#8722;0&#46;02&#59; p&#8239;&#61;&#8239;0&#46;840&#41;&#46; A sensitivity analysis confirmed the robustness of the results&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Study limitations</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">An important limitation of this study was the insufficient number of RCTs and the limited sample size&#46; In addition&#44; the study lacked a control group receiving a type of intervention other than the experimental protocol&#46; Another limitation was the short duration of follow-up&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conclusions</span><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">This study suggests that behavioral interventions could be effective in treating atopic dermatitis by reducing eczema and scratching severity&#46; Additionally&#44; habit-reversal behavioral therapy may be more effective for treating atopic dermatitis&#46;</p></span>"
        "secciones" => array:6 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Background"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Objectives"
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          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Methods"
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            "identificador" => "abst0020"
            "titulo" => "Results"
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            "identificador" => "abst0025"
            "titulo" => "Study limitations"
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            "identificador" => "abst0030"
            "titulo" => "Conclusions"
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        ]
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    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Study conducted at the Affiliated Hospital of Hangzhou Normal University&#44; Hangzhou&#44; Zhejiang&#44; China&#46;</p>"
      ]
    ]
    "apendice" => array:1 [
      0 => array:1 [
        "seccion" => array:1 [
          0 => array:4 [
            "apendice" => "<p id="par0180" class="elsevierStylePara elsevierViewall">The following is Supplementary data to this article&#58;<elsevierMultimedia ident="upi0005"></elsevierMultimedia></p>"
            "etiqueta" => "Appendix A"
            "titulo" => "Supplementary material"
            "identificador" => "sec0150"
          ]
        ]
      ]
    ]
    "multimedia" => array:8 [
      0 => array:8 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 2548
            "Ancho" => 2508
            "Tamanyo" => 436898
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        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0005"
            "detalle" => "Figure "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Flow chart of the process of selecting study&#46;</p>"
        ]
      ]
      1 => array:8 [
        "identificador" => "fig0010"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 1173
            "Ancho" => 1675
            "Tamanyo" => 214795
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        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0010"
            "detalle" => "Figure "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Risk of bias assessment of included studies&#46; In this figure&#44; Q1 to Q7 represents random sequence generation&#44; allocation concealment&#44; blinding of participants and personnel&#44; blinding of outcome assessment&#44; incomplete outcome data&#44; selective reporting outcome&#44; and other bias&#44; respectively&#46;</p>"
        ]
      ]
      2 => array:8 [
        "identificador" => "fig0015"
        "etiqueta" => "Figure 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr3.jpeg"
            "Alto" => 1632
            "Ancho" => 2925
            "Tamanyo" => 253476
          ]
        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0015"
            "detalle" => "Figure "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Meta-analysis of effect size of psychological interventions for relieving eczema severity&#46; CI&#44; Confidence Interval&#46;</p>"
        ]
      ]
      3 => array:8 [
        "identificador" => "fig0020"
        "etiqueta" => "Figure 4"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr4.jpeg"
            "Alto" => 1255
            "Ancho" => 2925
            "Tamanyo" => 140312
          ]
        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0020"
            "detalle" => "Figure "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Meta-analysis of effect size of psychological interventions for reducing itching intensity&#46; CI&#44; Confidence Interval&#46;</p>"
        ]
      ]
      4 => array:8 [
        "identificador" => "fig0025"
        "etiqueta" => "Figure 5"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr5.jpeg"
            "Alto" => 1490
            "Ancho" => 2925
            "Tamanyo" => 183650
          ]
        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0025"
            "detalle" => "Figure "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Meta-analysis of effect size of psychological interventions for reducing scratching severity&#46; CI&#44; Confidence Interval&#46;</p>"
        ]
      ]
      5 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
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        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0030"
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        "tabla" => array:2 [
          "leyenda" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">UMC&#44; Usual Medical Care&#59; DE&#44; Dermatological Education&#59; BT&#44; Behavioral Therapy&#59; ADAM&#44; Atopic Dermatitis Assessment Measure&#59; SCORAD&#44; Scoring Atopic Dermatitis&#59; N&#46;R&#46;&#44; Not Reported&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Study&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Country&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Setting&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Design&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Sample size&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mean age&#44; years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Percent female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Duration of disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Duration of treatment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Number of sessions&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Follow-up&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Outcome assessment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " rowspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ehlers&#44; et al&#46;&#44; 1995</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Germany</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Clinic-based</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">UMC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">68&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12 weeks</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 weeks</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Physician&#8217;s evaluation</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">DE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">60&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">BT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">57&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">DE&#8239;&#43;&#8239;BT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">62&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Habib&#44; et al&#46;&#44; 1999</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Australia</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Population-based</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">UMC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">33&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">87&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 weeks</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14 weeks</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ADAM</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">BT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">36&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">78&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Melin&#44; et al&#46;&#44; 1986</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sweden</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Clinic-based</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">UMC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30&#46;5</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">n&#46;r&#46;</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#46;R&#46;</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 weeks</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 weeks</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Physician&#8217;s evaluation</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">BT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Noren&#44; et al&#46;&#44; 1989</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sweden</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Clinic-based</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">UMC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24&#46;8</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">64&#37;</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#46;R&#46;</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 weeks</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 weeks</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Physician&#8217;s evaluation</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">BT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Schut&#44; et al&#46;&#44; 2013</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Germany</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Population-based</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">UMC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">71&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#46;R&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 weeks</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 weeks</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">SCORAD</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">BT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">71&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#46;R&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Noren&#44; et al&#46;&#44; 2018</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sweden</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Population-based</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">UMC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">72&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 weeks</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 weeks</td><td class="td" title="\n
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                  \t\t\t\t  " rowspan="2" align="left" valign="\n
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                  \t\t\t\t">SCORAD</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">BT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">18&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">8&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">62&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Ehlers&#44; et al&#46;&#44; 1995a&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#8722;0&#46;328 &#40;&#8722;0&#46;546 to &#8722;0&#46;069&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#8722;0&#46;073 &#40;&#8722;0&#46;326 to 0&#46;189&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">Habib&#44; et al&#46;&#44; 1999&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#8722;0&#46;499 &#40;&#8722;0&#46;790 to &#8722;0&#46;024&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">N&#46;R&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">N&#46;R&#46;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Melin&#44; et al&#46;&#44; 1986&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#8722;0&#46;426 &#40;&#8722;0&#46;761 to 0&#46;088&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0 &#40;&#8722;0&#46;496 to 0&#46;496&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#8722;0&#46;574 &#40;&#8722;0&#46;833 to &#8722;0&#46;109&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t">Noren&#44; et al&#46;&#44; 1989&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">BT vs&#46; UMC&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#8722;0&#46;346 &#40;&#8722;0&#46;581 to &#8722;0&#46;058&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">N&#46;R&#46;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Schut&#44; et al&#46;&#44; 2013&nbsp;\t\t\t\t\t\t\n
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                            0 => "E&#46; Kowalska-Ol&#281;dzka"
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                            3 => "G&#46; Girolomoni"
                            4 => "L&#46; Puig"
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                      "titulo" => "The prevalence of atopic dermatitis in adults&#58; systematic review on population studies"
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Informação do artigo
ISSN: 03650596
Idioma original: Inglês
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Anais Brasileiros de Dermatologia (Portuguese)
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