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etnia e de fatores do estilo de vida dos pacientes&#44; a etiologia da DA n&#227;o foi totalmente esclarecida&#46;<a class="elsevierStyleCrossRefs" href="#bib0255"><span class="elsevierStyleSup">7&#8211;9</span></a> Atualmente&#44; a aplica&#231;&#227;o t&#243;pica de emolientes e agentes anti&#8208;inflamat&#243;rios ainda &#233; a estrat&#233;gia b&#225;sica para o tratamento da DA&#46;<a class="elsevierStyleCrossRefs" href="#bib0270"><span class="elsevierStyleSup">10&#44;11</span></a> A terapia t&#243;pica n&#227;o &#233; eficaz no tratamento de uma propor&#231;&#227;o consider&#225;vel de pacientes com graus moderados e acentuados da doen&#231;a&#44;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">5</span></a> o que pode causar uma s&#233;rie de consequ&#234;ncias psicol&#243;gicas&#44; como dist&#250;rbios do sono&#44; ansiedade&#44; depress&#227;o e tens&#227;o financeira&#46;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">12</span></a> Al&#233;m disso&#44; tamb&#233;m foi demonstrado que fatores psicol&#243;gicos agravam os sintomas cut&#226;neos&#46;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">13</span></a> Portanto&#44; interven&#231;&#245;es psicol&#243;gicas s&#227;o consideradas indispens&#225;veis estrat&#233;gia de manejo multidisciplinar da DA&#46;<a class="elsevierStyleCrossRefs" href="#bib0290"><span class="elsevierStyleSup">14&#44;15</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">At&#233; o presente&#44; v&#225;rios estudos originais<a class="elsevierStyleCrossRefs" href="#bib0300"><span class="elsevierStyleSup">16&#8211;18</span></a> investigaram os efeitos terap&#234;uticos de diversas estrat&#233;gias de interven&#231;&#227;o psicol&#243;gica na DA&#46; Al&#233;m disso&#44; algumas metan&#225;lises<a class="elsevierStyleCrossRefs" href="#bib0315"><span class="elsevierStyleSup">19&#44;20</span></a> tamb&#233;m avaliaram sistematicamente o papel das interven&#231;&#245;es psicol&#243;gicas e educacionais no tratamento da DA&#46; No entanto&#44; os resultados de estudos publicados anteriormente sobre interven&#231;&#245;es psicol&#243;gicas para a DA s&#227;o conflitantes&#46; Observa&#8208;se que os efeitos terap&#234;uticos das interven&#231;&#245;es psicol&#243;gicas podem mudar&#44; de acordo com os diferentes tipos de interven&#231;&#245;es psicol&#243;gicas&#46;<a class="elsevierStyleCrossRefs" href="#bib0325"><span class="elsevierStyleSup">21&#44;22</span></a> Al&#233;m disso&#44; diferentes interven&#231;&#245;es psicol&#243;gicas foram combinadas como estrat&#233;gia de interven&#231;&#227;o individual nas metan&#225;lises anteriores&#44;<a class="elsevierStyleCrossRefs" href="#bib0315"><span class="elsevierStyleSup">19&#44;20</span></a> o que pode causar resultados conflitantes&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Como parte indispens&#225;vel das interven&#231;&#245;es psicol&#243;gicas&#44; a terapia comportamental refere&#8208;se &#224; aplica&#231;&#227;o de teorias modernas de aprendizagem e condicionamento no tratamento de transtornos comportamentais&#46;<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">23</span></a> Atualmente&#44; muitas t&#233;cnicas comportamentais t&#234;m sido usadas na pr&#225;tica cl&#237;nica&#44; como terapia cognitivo&#8208;comportamental&#44; terapia de revers&#227;o de h&#225;bitos e terapia comportamental dial&#233;tica&#46;<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">23</span></a> Dessas t&#233;cnicas&#44; a terapia de revers&#227;o de h&#225;bitos<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">24</span></a> e a terapia cognitivo&#8208;comportamental<a class="elsevierStyleCrossRefs" href="#bib0345"><span class="elsevierStyleSup">25&#44;26</span></a> t&#234;m sido utilizadas com sucesso em dermatologia&#46; A terapia de revers&#227;o de h&#225;bitos foi inicialmente descrita por Azrin e Nunn como a resposta competitiva produzida pela contra&#231;&#227;o muscular com antagonista&#46;<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">27</span></a> A terapia de revers&#227;o de h&#225;bitos consiste em m&#250;ltiplos componentes&#44; mas o treinamento de resposta concorrente e o treinamento de conscientiza&#231;&#227;o representam suas t&#233;cnicas mais eficazes&#46;<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">28</span></a> J&#225; a terapia cognitivo&#8208;comportamental &#233; uma combina&#231;&#227;o de abordagens cognitivas e comportamentais que pode ajudar o paciente a reconhecer seus pensamentos distorcidos e comportamentos ineficazes&#46;<a class="elsevierStyleCrossRef" href="#bib0365"><span class="elsevierStyleSup">29</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">V&#225;rios estudos<a class="elsevierStyleCrossRefs" href="#bib0340"><span class="elsevierStyleSup">24&#44;26</span></a> exploraram o potencial da terapia de revers&#227;o de h&#225;bitos e da terapia cognitivo&#8208;comportamental no tratamento da DA&#46; Bewley relatou que pacientes com DA que receberam tr&#234;s semanas de terapia de revers&#227;o de h&#225;bitos tiveram escores de DA significantemente melhores do que aqueles que receberam tratamentos t&#243;picos isolados&#46;<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">24</span></a> Goyonlo et al&#46; sugeriram que a terapia cognitivo&#8208;comportamental ajudou pacientes com dermatite a melhorar os escores de gravidade cl&#237;nica&#46;<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">26</span></a> Que seja de conhecimento dos autores&#44; n&#227;o houve nenhuma metan&#225;lise relevante avaliando os efeitos de interven&#231;&#245;es comportamentais na DA&#46; Portanto&#44; a presente metan&#225;lise foi conduzida para avaliar os efeitos de interven&#231;&#245;es comportamentais isoladas nos resultados de controle da doen&#231;a em pacientes com DA&#46; O objetivo foi fornecer recomenda&#231;&#227;o definitiva baseada em evid&#234;ncias para interven&#231;&#245;es comportamentais em pacientes com DA&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">M&#233;todos</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Desenho do estudo</span><p id="par0030" class="elsevierStylePara elsevierViewall">Esta revis&#227;o sistem&#225;tica e metan&#225;lise foi realizada seguindo a estrutura recomendada pelo <span class="elsevierStyleItalic">Cochrane Handbook</span>&#44;<a class="elsevierStyleCrossRef" href="#bib0370"><span class="elsevierStyleSup">30</span></a> e foi relatada em estrita conformidade com a lista de verifica&#231;&#227;o <span class="elsevierStyleItalic">Preferred Reporting Items for Systematic Reviews and Meta&#8208;Analysis</span> &#40;PRISMA&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0375"><span class="elsevierStyleSup">31</span></a> portanto&#44; garante fortemente a transpar&#234;ncia e confiabilidade da condu&#231;&#227;o da metan&#225;lise atual&#46; Todos eles cumprem o requisito de registo de protocolo formal em plataforma p&#250;blica&#44; portanto n&#227;o foi registado protocolo adicional para esta metan&#225;lise&#46; Este estudo n&#227;o exigiu aprova&#231;&#227;o &#233;tica e consentimento informado dos pacientes&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Crit&#233;rios de sele&#231;&#227;o</span><p id="par0035" class="elsevierStylePara elsevierViewall">Dois revisores independentes seguiram rigorosamente os crit&#233;rios estabelecidos para selecionar os artigos recuperados&#46; Quando houve diverg&#234;ncia sobre a recupera&#231;&#227;o da literatura&#44; consultou&#8208;se um terceiro revisor&#46; Foram elaboradas tr&#234;s etapas para sele&#231;&#227;o dos estudos&#58; a&#41; remo&#231;&#227;o de estudos duplicados com base no <span class="elsevierStyleItalic">software</span> EndNote&#59; b&#41; avalia&#231;&#227;o inicial de elegibilidade com base na avalia&#231;&#227;o de t&#237;tulos e resumos&#59; e c&#41; avalia&#231;&#227;o final de elegibilidade com base na avalia&#231;&#227;o dos textos completos&#46;</p><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Crit&#233;rio de inclus&#227;o</span><p id="par0040" class="elsevierStylePara elsevierViewall">A elegibilidade de cada estudo foi avaliada utilizando a sigla PICOS&#44; incluindo pacientes &#40;P&#41;&#44; interven&#231;&#227;o &#40;I&#41;&#44; compara&#231;&#227;o &#40;C&#41;&#44; desfecho &#40;O&#44;&#46; do ingl&#234;s <span class="elsevierStyleItalic">outcome</span>&#41; e desenho do estudo &#40;S&#41;&#58; a&#41; os pacientes foram diagnosticados com DA por m&#233;dico dermatologista com base em crit&#233;rios reconhecidos &#40;sigla P&#41;&#59; b&#41; os pacientes do grupo experimental foram instru&#237;dos a receber interven&#231;&#245;es comportamentais al&#233;m dos cuidados m&#233;dicos usuais para DA &#40;sigla I&#41;&#59; c&#41; os pacientes do grupo controle receberam apenas cuidados m&#233;dicos usuais &#40;sigla C&#41;&#59; d&#41; pelo menos um dos seguintes&#58; gravidade do eczema&#44; intensidade do prurido e gravidade da escoria&#231;&#227;o foi relatado de maneira eficaz &#40;sigla O&#41;&#59; e&#41; os pacientes foram distribu&#237;dos aleatoriamente em diferentes grupos &#40;sigla S&#41;&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Crit&#233;rio de exclus&#227;o</span><p id="par0045" class="elsevierStylePara elsevierViewall">Os estudos foram exclu&#237;dos de acordo com os seguintes crit&#233;rios&#58; a&#41; as interven&#231;&#245;es comportamentais foram concebidas como parte do protocolo psicol&#243;gico&#44; em vez de interven&#231;&#227;o isolada&#59; b&#41; dados sobre o coeficiente de correla&#231;&#227;o &#40;r&#41; n&#227;o estavam dispon&#237;veis&#59; c&#41; foi utilizado desenho de estudo ineleg&#237;vel&#44; como estudos quase&#8208;randomizados&#44; estudos observacionais e estudos com animais&#59; d&#41; estudos duplicados com amostras sobrepostas&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Fontes de informa&#231;&#227;o</span><p id="par0050" class="elsevierStylePara elsevierViewall">Foram pesquisadas sistematicamente tr&#234;s bases de dados comuns em ingl&#234;s&#44; incluindo PubMed&#44; EMBASE e Cochrane Central Registry for Controlled Trials &#40;CENTRAL&#41;&#44; para recuperar ensaios controlados randomizados &#40;ECR&#41; relevantes sobre a aplica&#231;&#227;o de interven&#231;&#245;es comportamentais em pacientes com DA desde o seu in&#237;cio at&#233; fevereiro de 2022&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Estrat&#233;gia de busca</span><p id="par0055" class="elsevierStylePara elsevierViewall">A estrat&#233;gia de busca foi desenvolvida utilizando termos de assunto e palavras livres como segue&#58; &#8220;<span class="elsevierStyleItalic">atopic dermatitis&#8221;</span>&#44; <span class="elsevierStyleItalic">&#8220;habit&#8208;reversal&#8221;</span>&#44; <span class="elsevierStyleItalic">&#8220;behavior therapy&#8221;</span>&#44; <span class="elsevierStyleItalic">&#8220;behavior modification&#8221;</span>&#44; <span class="elsevierStyleItalic">&#8220;behavior change&#8221;</span>&#44; e &#8220;<span class="elsevierStyleItalic">behavior treatment</span>&#8221;&#46; Dois revisores independentes conduziram a busca e a atualizaram semanalmente para evitar a perda de estudos potencialmente eleg&#237;veis&#46; Tamb&#233;m foram identificados estudos relevantes adicionais por meio das refer&#234;ncias dos estudos inclu&#237;dos e metan&#225;lises relacionadas ao t&#243;pico&#46; N&#227;o houve restri&#231;&#227;o do <span class="elsevierStyleItalic">status</span> da publica&#231;&#227;o na recupera&#231;&#227;o da literatura&#46; As estrat&#233;gias de busca detalhadas dos bancos de dados alvo s&#227;o mostradas na <a class="elsevierStyleCrossRef" href="#sec0145">tabela S1</a>&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Extra&#231;&#227;o de dados</span><p id="par0060" class="elsevierStylePara elsevierViewall">Dois revisores independentes extra&#237;ram as informa&#231;&#245;es essenciais dos estudos eleg&#237;veis utilizando formul&#225;rio padr&#227;o elaborado previamente&#46; Foram extra&#237;das as seguintes informa&#231;&#245;es&#58; autores&#44; ano de publica&#231;&#227;o&#44; pa&#237;s&#44; tamanho amostral&#44; percentual de pacientes do sexo feminino&#44; m&#233;dia de idade dos pacientes&#44; dura&#231;&#227;o da DA&#44; detalhes do agrupamento&#44; dura&#231;&#227;o da interven&#231;&#227;o&#44; n&#250;mero de sess&#245;es&#44; dura&#231;&#227;o do seguimento&#44; resultados detalhados de interesse e informa&#231;&#245;es para avalia&#231;&#227;o da qualidade&#46; Os autores tamb&#233;m foram contatados para obter mais informa&#231;&#245;es&#44; quando necess&#225;rio&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Avalia&#231;&#227;o do desfecho</span><p id="par0065" class="elsevierStylePara elsevierViewall">Esta metan&#225;lise avaliou tr&#234;s desfechos&#44; incluindo gravidade do eczema&#44; intensidade do prurido e gravidade da escoria&#231;&#227;o&#46; A gravidade do eczema foi medida utilizando o <span class="elsevierStyleItalic">Scoring the Severity of Atopic Dermatitis</span> &#40;SCORAD&#41;&#44; o SCORAD Modificado&#44; o <span class="elsevierStyleItalic">Atopic Dermatitis Assessment Measure</span> &#40;ADAM&#41; ou os m&#233;todos de escore originais dos autores&#44; e a intensidade do prurido e da escoria&#231;&#227;o foi medida usando escala subjetiva do tipo Likert&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Avalia&#231;&#227;o de risco de vi&#233;s</span><p id="par0070" class="elsevierStylePara elsevierViewall">A avalia&#231;&#227;o da qualidade foi conduzida por dois revisores independentes usando a ferramenta de avalia&#231;&#227;o de risco de vi&#233;s da Cochrane&#46;<a class="elsevierStyleCrossRef" href="#bib0380"><span class="elsevierStyleSup">32</span></a> Nessa ferramenta de avalia&#231;&#227;o&#44; sete itens estavam envolvidos&#44; incluindo gera&#231;&#227;o de sequ&#234;ncia aleat&#243;ria &#40;vi&#233;s de sele&#231;&#227;o&#41;&#44; oculta&#231;&#227;o de aloca&#231;&#227;o &#40;vi&#233;s de sele&#231;&#227;o&#41;&#44; cegamento de participantes e pessoal &#40;vi&#233;s de desempenho&#41;&#44; cegamento de avalia&#231;&#227;o de desfechos &#40;vi&#233;s de detec&#231;&#227;o&#41;&#44; dados de desfechos incompletos &#40;vi&#233;s de atrito&#41;&#44; vi&#233;s de relato seletivo &#40;vi&#233;s de relato&#41; e outros vieses&#46; Cada item foi classificado como risco &#8220;baixo&#8221;&#44; &#8220;incerto&#8221; ou &#8220;alto&#8221; com base nas informa&#231;&#245;es reais relatadas nos estudos&#46; Por fim&#44; a qualidade geral de cada estudo foi avaliada como n&#237;vel &#8220;baixo&#8221;&#44; &#8220;moderado&#8221; ou &#8220;alto&#8221;&#46; Especificamente&#44; a qualidade metodol&#243;gica global foi avaliada como &#8220;alta&#8221; se todos os itens fossem classificados como de &#8220;baixo&#8221; risco&#44; &#8220;baixa&#8221; se pelo menos um dos sete itens fosse classificado como &#8220;alto&#8221; risco&#44; ou &#8220;moderada&#8221; se pelo menos um dos sete itens fosse classificado como risco &#8220;incerto&#8221;&#44; mas nenhum fosse classificado como risco &#8220;alto&#8221;&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">An&#225;lise estat&#237;stica</span><p id="par0075" class="elsevierStylePara elsevierViewall">Esta metan&#225;lise utilizou o <span class="elsevierStyleItalic">software</span> Stata 14&#46;0 &#40;State Corporation&#44; Lake Way&#44; Texas&#44; EUA&#41; para calcular o tamanho do efeito&#44; que foi expresso como coeficiente de correla&#231;&#227;o &#40;r&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0385"><span class="elsevierStyleSup">33</span></a> A heterogeneidade estat&#237;stica entre os estudos foi testada usando as estat&#237;sticas Cochrane Q<a class="elsevierStyleCrossRefs" href="#bib0390"><span class="elsevierStyleSup">34&#44;35</span></a> e I<span class="elsevierStyleSup">2</span>&#46;<a class="elsevierStyleCrossRef" href="#bib0400"><span class="elsevierStyleSup">36</span></a> Os estudos foram considerados homog&#234;neos se p<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#44;1 e I<span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>50&#37;&#59; caso contr&#225;rio&#44; eles eram considerados heterog&#234;neos&#46; O modelo de efeitos aleat&#243;rios foi selecionado para todas as an&#225;lises estat&#237;sticas&#44; independentemente do n&#237;vel de heterogeneidade estat&#237;stica&#44; porque esse modelo incorporou a vari&#226;ncia resultante das diferen&#231;as entre estudos e dentro dos estudos no c&#225;lculo das estimativas&#46;<a class="elsevierStyleCrossRef" href="#bib0395"><span class="elsevierStyleSup">35</span></a> O valor de r correspondente foi calculado de acordo com os dados relatados nos estudos inclu&#237;dos usando calculadora <span class="elsevierStyleItalic">online</span> chamada &#8220;<span class="elsevierStyleItalic">Practical Meta&#8208;Analysis Effect Size Calculator</span>&#8221;&#44; projetada por Wilson et al&#46; para facilitar o c&#225;lculo de tamanhos de efeito para metan&#225;lises&#46;<a class="elsevierStyleCrossRef" href="#bib0405"><span class="elsevierStyleSup">37</span></a> Uma an&#225;lise de sensibilidade foi realizada para examinar a robustez dos resultados para a gravidade do eczema por meio do m&#233;todo &#8220;<span class="elsevierStyleItalic">leave&#8208;one&#8208;out&#8221;</span>&#46; Por fim&#44; o exame de vi&#233;s de publica&#231;&#227;o para metan&#225;lise da gravidade do eczema foi conduzido usando a regress&#227;o linear de Egger e os m&#233;todos de rela&#231;&#227;o de classifica&#231;&#227;o de Begg&#44; embora o n&#250;mero cumulativo de estudos eleg&#237;veis n&#227;o exceda dez&#46;<a class="elsevierStyleCrossRef" href="#bib0410"><span class="elsevierStyleSup">38</span></a></p></span></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Resultados</span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Busca na literatura</span><p id="par0080" class="elsevierStylePara elsevierViewall">Foram recuperados 237 registros de bases de dados eletr&#244;nicas usando estrat&#233;gias de busca elaboradas previamente&#46; Ap&#243;s a remo&#231;&#227;o de 36 registros duplicados&#44; 201 estudos &#250;nicos foram retidos para avalia&#231;&#227;o inicial de elegibilidade&#46; Foram exclu&#237;dos 194 estudos considerados ineleg&#237;veis ap&#243;s triagem dos t&#237;tulos e resumos&#44; por n&#227;o terem rela&#231;&#227;o com o tema &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>183&#41;&#44; protocolo de estudo registrado &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>8&#41; e metan&#225;lise &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#41;&#46; Em seguida&#44; foram recuperados os textos completos dos sete estudos restantes para posterior avalia&#231;&#227;o de elegibilidade&#46; Ap&#243;s a exclus&#227;o de dois estudos ineleg&#237;veis em virtude de t&#243;picos ineleg&#237;veis&#44; cinco estudos<a class="elsevierStyleCrossRefs" href="#bib0415"><span class="elsevierStyleSup">39&#8211;43</span></a> foram considerados por atenderem aos crit&#233;rios de sele&#231;&#227;o&#46; Al&#233;m disso&#44; foi identificado outro estudo eleg&#237;vel<a class="elsevierStyleCrossRef" href="#bib0440"><span class="elsevierStyleSup">44</span></a> de uma metan&#225;lise anterior&#46; Por fim&#44; seis ECR<a class="elsevierStyleCrossRefs" href="#bib0415"><span class="elsevierStyleSup">39&#8211;44</span></a> envolvendo sete relatos foram inclu&#237;dos na presente metan&#225;lise&#44; porque o estudo de Ehlers et al&#46;<a class="elsevierStyleCrossRef" href="#bib0440"><span class="elsevierStyleSup">44</span></a> comparou a efic&#225;cia de quatro grupos de tratamentos para DA&#46; O processo detalhado de sele&#231;&#227;o do estudo &#233; mostrado na <a class="elsevierStyleCrossRef" href="#fig0005">figura 1</a>&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Caracter&#237;sticas dos estudos</span><p id="par0085" class="elsevierStylePara elsevierViewall">As caracter&#237;sticas b&#225;sicas detalhadas dos estudos inclu&#237;dos s&#227;o apresentadas na <a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a>&#46; No estudo atual&#44; foram inclu&#237;dos 246 pacientes&#46;<a class="elsevierStyleCrossRefs" href="#bib0415"><span class="elsevierStyleSup">39&#8211;44</span></a> Cinco estudos<a class="elsevierStyleCrossRefs" href="#bib0415"><span class="elsevierStyleSup">39&#44;40&#44;42&#8211;44</span></a> inclu&#237;ram pacientes adultos&#59; pacientes pedi&#225;tricos foram inclu&#237;dos em apenas um estudo&#46;<a class="elsevierStyleCrossRef" href="#bib0420"><span class="elsevierStyleSup">40</span></a> Entre os seis estudos considerados&#44; tr&#234;s<a class="elsevierStyleCrossRefs" href="#bib0420"><span class="elsevierStyleSup">40&#8211;42</span></a> desenvolveram terapia comportamental de revers&#227;o de h&#225;bitos e outros tr&#234;s<a class="elsevierStyleCrossRefs" href="#bib0415"><span class="elsevierStyleSup">39&#44;43&#44;44</span></a> desenvolveram terapia cognitivo&#8208;comportamental para o tratamento da DA&#46; Tr&#234;s estudos<a class="elsevierStyleCrossRefs" href="#bib0420"><span class="elsevierStyleSup">40&#44;42&#44;44</span></a> designaram um m&#233;dico para avaliar os resultados&#59; dois estudos<a class="elsevierStyleCrossRefs" href="#bib0425"><span class="elsevierStyleSup">41&#44;43</span></a> mediram os resultados com o SCORAD&#59; e um estudo<a class="elsevierStyleCrossRef" href="#bib0415"><span class="elsevierStyleSup">39</span></a> utilizou a ADAM para avaliar os resultados&#46; Os tamanhos dos efeitos dos estudos inclu&#237;dos em rela&#231;&#227;o aos desfechos&#8208;alvo de interesse s&#227;o apresentados na <a class="elsevierStyleCrossRef" href="#tbl0010">tabela 2</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Risco de vi&#233;s</span><p id="par0090" class="elsevierStylePara elsevierViewall">Apenas um estudo<a class="elsevierStyleCrossRef" href="#bib0425"><span class="elsevierStyleSup">41</span></a> introduziu especificamente o m&#233;todo de gera&#231;&#227;o de sequ&#234;ncias aleat&#243;rias e oculta&#231;&#227;o de aloca&#231;&#227;o&#46; Todos os estudos<a class="elsevierStyleCrossRefs" href="#bib0415"><span class="elsevierStyleSup">39&#8211;44</span></a> foram classificados como de risco incerto para cegamento dos participantes e pessoal&#44; e um estudo<a class="elsevierStyleCrossRef" href="#bib0440"><span class="elsevierStyleSup">44</span></a> foi classificado como de alto risco para cegamento da avalia&#231;&#227;o dos resultados&#46; Todos os estudos<a class="elsevierStyleCrossRefs" href="#bib0415"><span class="elsevierStyleSup">39&#8211;44</span></a> foram classificados como de baixo risco para vi&#233;s de atrito e vi&#233;s de relato&#44; mas de alto risco para outros vieses em virtude do tamanho amostral extremamente insuficiente&#46; Os resultados detalhados da avalia&#231;&#227;o da qualidade s&#227;o apresentados na <a class="elsevierStyleCrossRef" href="#fig0010">figura 2</a>&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Resultados da metan&#225;lise</span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Gravidade do eczema</span><p id="par0095" class="elsevierStylePara elsevierViewall">Todos os estudos inclu&#237;dos&#44;<a class="elsevierStyleCrossRefs" href="#bib0415"><span class="elsevierStyleSup">39&#8211;44</span></a> envolvendo sete relatos com 246 pacientes&#44; avaliaram o efeito de interven&#231;&#245;es comportamentais na gravidade do eczema&#46; O exame de heterogeneidade indicou que todos os estudos foram homog&#234;neos para an&#225;lise da gravidade do eczema &#40;I<span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;890&#41;&#46; A metan&#225;lise indicou que&#44; em compara&#231;&#227;o com os cuidados m&#233;dicos tradicionais&#44; as interven&#231;&#245;es comportamentais aliviaram a gravidade do eczema de maneira mais eficaz &#40;tamanho do efeito &#91;IC 95&#37;&#93;&#58; &#8722;0&#44;39 &#91;&#8722;0&#44;50&#44; &#8722;0&#44;28&#93;&#59; z<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;7&#44;003&#44; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; O gr&#225;fico em <span class="elsevierStyleItalic">forest plot</span> foi representado na <a class="elsevierStyleCrossRef" href="#fig0015">figura 3</a>&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0095" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Intensidade do prurido</span><p id="par0100" class="elsevierStylePara elsevierViewall">Entre os seis estudos inclu&#237;dos&#44; dois deles<a class="elsevierStyleCrossRefs" href="#bib0420"><span class="elsevierStyleSup">40&#44;44</span></a> envolvendo tr&#234;s relatos avaliaram o efeito de interven&#231;&#245;es comportamentais na intensidade do prurido&#46; Todos os estudos foram considerados homog&#234;neos para essa an&#225;lise &#40;I<span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;842&#41;&#46; A metan&#225;lise sugeriu que as interven&#231;&#245;es comportamentais foram compar&#225;veis aos cuidados m&#233;dicos tradicionais em termos de intensidade do prurido&#44; com tamanho de efeito pequeno de &#8722;0&#44;02 &#40;IC95&#37; &#8722;0&#44;19 a 0&#44;16&#59; z<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#44;202&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;840&#41;&#46; O gr&#225;fico em <span class="elsevierStyleItalic">forest plot</span> est&#225; representado na <a class="elsevierStyleCrossRef" href="#fig0020">figura 4</a>&#46;</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia></span><span id="sec0100" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Gravidade da escoria&#231;&#227;o</span><p id="par0105" class="elsevierStylePara elsevierViewall">Quatro estudos envolvendo cinco relatos<a class="elsevierStyleCrossRefs" href="#bib0420"><span class="elsevierStyleSup">40&#8211;42&#44;44</span></a> avaliaram o efeito de interven&#231;&#245;es comportamentais na gravidade da escoria&#231;&#227;o&#46; O exame de heterogeneidade n&#227;o detectou heterogeneidade estat&#237;stica substancial entre os estudos para essa an&#225;lise da gravidade da escoria&#231;&#227;o &#40;I<span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>34&#44;2&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;194&#41;&#46; O resultado da metan&#225;lise sugeriu que as interven&#231;&#245;es comportamentais estavam associadas &#224; diminui&#231;&#227;o da gravidade da escoria&#231;&#227;o em compara&#231;&#227;o com os cuidados m&#233;dicos usuais&#44; com tamanho de efeito de &#8722;0&#44;19 &#40;IC95&#37; &#8722;0&#44;35 a &#8722;0&#44;03&#59; z<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;2&#44;377&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;017&#41;&#46; O gr&#225;fico em <span class="elsevierStyleItalic">forest plot</span> est&#225; representado na <a class="elsevierStyleCrossRef" href="#fig0025">figura 5</a>&#46;</p><elsevierMultimedia ident="fig0025"></elsevierMultimedia></span><span id="sec0105" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">An&#225;lise de subgrupos</span><p id="par0110" class="elsevierStylePara elsevierViewall">Conforme apresentado neste estudo&#44; dois tipos de interven&#231;&#245;es comportamentais foram identificados nessa metan&#225;lise&#44; incluindo terapia comportamental de revers&#227;o de h&#225;bitos e terapia cognitivo&#8208;comportamental&#46; Portanto&#44; os autores analisaram os subgrupos de acordo com os tipos de interven&#231;&#245;es&#46; Os resultados da an&#225;lise de subgrupos sugeriram que tanto a terapia comportamental de revers&#227;o de h&#225;bitos quanto a terapia cognitivo&#8208;comportamental aliviaram efetivamente a gravidade do eczema&#44; mas apenas a terapia comportamental de revers&#227;o de h&#225;bitos reduziu significantemente a gravidade da escoria&#231;&#227;o&#46; Os resultados detalhados das an&#225;lises de subgrupos s&#227;o apresentados na <a class="elsevierStyleCrossRef" href="#sec0145">figura S1</a>&#46;</p></span><span id="sec0110" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">An&#225;lise de sensibilidade</span><p id="par0115" class="elsevierStylePara elsevierViewall">Para analisar a gravidade do eczema foi utilizado o m&#233;todo <span class="elsevierStyleItalic">leave&#8208;one&#8208;out</span> para examinar a robustez do efeito sintetizado&#46; Como apresentado na <a class="elsevierStyleCrossRef" href="#sec0145">figura S2</a>&#44; o efeito sintetizado n&#227;o foi alterado significantemente ap&#243;s a remo&#231;&#227;o de qualquer estudo uma s&#243; vez&#44; indicando a robustez e credibilidade do efeito sintetizado no estudo atual&#46;</p></span><span id="sec0115" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0155">Vi&#233;s de publica&#231;&#227;o</span><p id="par0120" class="elsevierStylePara elsevierViewall">O vi&#233;s de publica&#231;&#227;o dos estudos inclu&#237;dos para an&#225;lise da gravidade do eczema foi avaliado por meio do teste de Egger e do teste de Begg&#46; Como mostrado na <a class="elsevierStyleCrossRef" href="#sec0145">figura S3</a>&#44; foi gerado um gr&#225;fico de funil sim&#233;trico para o teste de Egger &#40;z<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#44;15&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;881&#41; e o teste de Begg &#40;t<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#44;19&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;853&#41;&#44; sugerindo aus&#234;ncia de vi&#233;s de publica&#231;&#227;o&#46;</p></span></span></span><span id="sec0120" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0160">Discuss&#227;o</span><p id="par0125" class="elsevierStylePara elsevierViewall">Embora as interven&#231;&#245;es psicol&#243;gicas tenham sido clinicamente reconhecidas como eficazes&#44; seus benef&#237;cios no tratamento da DA ainda s&#227;o controversos&#46; Esta metan&#225;lise incluiu seis ECR para an&#225;lise de dados&#46; Os resultados sugerem que as interven&#231;&#245;es comportamentais s&#227;o mais eficazes do que os cuidados m&#233;dicos usuais no al&#237;vio do eczema e da gravidade do prurido&#46; Al&#233;m disso&#44; a terapia comportamental de revers&#227;o de h&#225;bitos &#233; uma interven&#231;&#227;o mais eficaz para o tratamento da DA porque uma an&#225;lise separada demonstra ainda mais seus benef&#237;cios no al&#237;vio do eczema e na gravidade da escoria&#231;&#227;o&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Atualmente&#44; duas metan&#225;lises publicadas<a class="elsevierStyleCrossRefs" href="#bib0315"><span class="elsevierStyleSup">19&#44;20</span></a> avaliaram os efeitos de interven&#231;&#245;es psicol&#243;gicas e educacionais na DA&#46; Chida et al&#46;<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">19</span></a> inclu&#237;ram oito estudos em sua metan&#225;lise e identificaram oito tipos de interven&#231;&#227;o&#58; aromaterapia&#44; treinamento autog&#234;nico&#44; psicoterapia din&#226;mica breve&#44; terapia cognitivo&#8208;comportamental&#44; educa&#231;&#227;o dermatol&#243;gica combinada com terapia cognitivo&#8208;comportamental&#44; terapia comportamental de revers&#227;o de h&#225;bitos&#44; programa de gerenciamento de estresse e programas educacionais estruturados&#46; Depois de calcular o efeito sintetizado&#44; descobriram que o papel das interven&#231;&#245;es psicol&#243;gicas no tratamento da DA era prematuro&#44; embora tivesse efeito de melhora significante na gravidade do eczema&#44; na intensidade do prurido e grau de escoria&#231;&#227;o em pacientes com DA&#46; Em 2017&#44; Hashimoto et al&#46; conduziram outra metan&#225;lise para investigar o efeito de interven&#231;&#245;es psicol&#243;gicas e educacionais na DA&#46;<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">20</span></a> Os resultados agrupados de tr&#234;s ECR n&#227;o sugeriram diferen&#231;a significante na gravidade do eczema entre os dois grupos&#46; Os efeitos de diferentes interven&#231;&#245;es psicol&#243;gicas e educacionais foram diferentes&#46;<a class="elsevierStyleCrossRefs" href="#bib0325"><span class="elsevierStyleSup">21&#44;22</span></a> No entanto&#44; duas metan&#225;lises publicadas anteriormente apenas incorporaram diferentes tipos de interven&#231;&#245;es em um regime individual&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Nesta metan&#225;lise&#44; os autores investigaram especificamente os efeitos puros de interven&#231;&#245;es comportamentais sobre os resultados de sa&#250;de em pacientes com DA&#44; em compara&#231;&#227;o com metan&#225;lises anteriores&#46; Al&#233;m disso&#44; avaliaram os efeitos da terapia comportamental de revers&#227;o de h&#225;bitos e da terapia cognitivo&#8208;comportamental no tratamento da DA&#44; fornecendo recomenda&#231;&#245;es definitivas baseadas em evid&#234;ncias para a tomada de decis&#245;es cl&#237;nicas&#46; Mais importante ainda&#44; nesta metan&#225;lise foi avaliado o papel das interven&#231;&#245;es comportamentais no tratamento da DA&#44; calculando a magnitude do efeito terap&#234;utico com base no coeficiente de correla&#231;&#227;o&#46; Por fim&#44; foi avaliada a heterogeneidade estat&#237;stica entre os estudos para o desfecho individual&#46; Foram calculados todos os efeitos sintetizados com o modelo de efeitos aleat&#243;rios&#44; que considerou simultaneamente varia&#231;&#245;es entre estudos e dentro dos estudos&#46; Portanto&#44; esta metan&#225;lise gerou tamanhos de efeito relativamente conservadores&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Entretanto&#44; a presente metan&#225;lise continua a ter algumas limita&#231;&#245;es&#46; Em primeiro lugar&#44; apenas seis estudos eleg&#237;veis com amostras extremamente insuficientes foram inclu&#237;dos nessa metan&#225;lise&#46; Portanto&#44; os resultados atuais devem ser interpretados com cautela em virtude do poder estat&#237;stico inadequado&#46; Em segundo lugar&#44; os pacientes inscritos nos estudos originais foram recrutados de diversas origens&#44; incluindo origens cl&#237;nicas e populacionais&#44; o que pode introduzir vi&#233;s nesses achados&#46; Terceiro&#44; cinco estudos inclu&#237;ram pacientes adultos&#44; exceto um&#44; no qual foram inclu&#237;dos pacientes pedi&#225;tricos&#46; No entanto&#44; foi realizada an&#225;lise de sensibilidade para examinar a robustez do efeito sintetizado utilizando o m&#233;todo <span class="elsevierStyleItalic">leave&#8208;one&#8208;out</span>&#46; A an&#225;lise de sensibilidade indicou que as interven&#231;&#245;es comportamentais podem ser mais eficazes para pacientes pedi&#225;tricos&#44; mas o resultado agrupado n&#227;o mudou estatisticamente&#46; Quarto&#44; n&#227;o foi realizada an&#225;lise de subgrupo para eliminar o efeito das varia&#231;&#245;es na dura&#231;&#227;o da doen&#231;a&#44; dura&#231;&#227;o do tratamento&#44; n&#250;mero de sess&#245;es&#44; dura&#231;&#227;o do seguimento e m&#233;todo de avalia&#231;&#227;o dos resultados em virtude do n&#250;mero insuficiente de estudos eleg&#237;veis&#46; Quinto&#44; como indicado na subse&#231;&#227;o do desenho do estudo&#44; o protocolo do estudo n&#227;o foi registrado em nenhuma plataforma p&#250;blica&#46; No entanto&#44; esta metan&#225;lise foi conduzida para garantir a transpar&#234;ncia e a confiabilidade em estrita conformidade com o <span class="elsevierStyleItalic">Cochrane Handbook</span> e as declara&#231;&#245;es PRISMA&#46; Sexto&#44; um estudo comparou a interven&#231;&#227;o comportamental combinada associada a uma estrat&#233;gia educacional com a estrat&#233;gia educacional isoladamente&#59; no entanto&#44; ele tamb&#233;m foi inclu&#237;do na an&#225;lise final&#44; o que pode introduzir vi&#233;s nos resultados agrupados em virtude das varia&#231;&#245;es no controle&#46; Notavelmente&#44; a an&#225;lise de sensibilidade com base na estrat&#233;gia <span class="elsevierStyleItalic">leave&#8208;one&#8208;out</span> sugeriu que a inclus&#227;o desse estudo n&#227;o afetou significantemente a confiabilidade dos resultados agrupados&#46; Por fim&#44; embora o exame para an&#225;lise da gravidade do eczema n&#227;o tenha mostrado risco de vi&#233;s de publica&#231;&#227;o&#44; deve&#8208;se reconhecer que o n&#250;mero cumulativo de estudos eleg&#237;veis n&#227;o atendeu aos crit&#233;rios m&#237;nimos de realiza&#231;&#227;o do exame de vi&#233;s de publica&#231;&#227;o&#44; sendo&#44; portanto&#44; dif&#237;cil eliminar o risco de obter resultados falso negativos&#46;</p></span><span id="sec0125" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0165">Conclus&#227;o</span><p id="par0145" class="elsevierStylePara elsevierViewall">Com base nas evid&#234;ncias atualmente dispon&#237;veis&#44; a presente metan&#225;lise indica que as interven&#231;&#245;es comportamentais podem ser eficazes no al&#237;vio da gravidade do eczema e da escoria&#231;&#227;o&#46; Al&#233;m disso&#44; a terapia comportamental de revers&#227;o de h&#225;bitos pode ser mais eficaz no tratamento da DA&#46; Entretanto&#44; deve&#8208;se reconhecer que o resultado da gravidade da escoria&#231;&#227;o n&#227;o apresenta acur&#225;cia em virtude do pequeno n&#250;mero de pacientes e dos limites inferiores do IC de valor quase nulo&#46; Mais importante ainda&#44; todos os resultados foram avaliados apenas em perspectiva estatisticamente significante e n&#227;o de relev&#226;ncia cl&#237;nica&#46; Portanto&#44; os achados do presente estudo devem ser validados a partir de uma perspectiva clinicamente relevante em estudos futuros&#46;</p></span><span id="sec0130" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0170">Suporte financeiro</span><p id="par0150" class="elsevierStylePara elsevierViewall">Este artigo foi apoiado pelo Fundo de Pesquisa de Projeto Especial de Apoio ao Desenvolvimento da Ind&#250;stria Biom&#233;dica e de Sa&#250;de de Hangzhou &#40;2021WJCY294&#41;&#46; Os &#243;rg&#227;os financiadores n&#227;o tiveram nenhum papel na concep&#231;&#227;o do estudo e na coleta&#44; an&#225;lise e interpreta&#231;&#227;o dos dados e na reda&#231;&#227;o do manuscrito&#46;</p></span><span id="sec0135" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0175">Contribui&#231;&#227;o dos autores</span><p id="par0155" class="elsevierStylePara elsevierViewall">Wenying Zhong&#58; Concep&#231;&#227;o e planejamento do estudo&#59; Reda&#231;&#227;o do manuscrito ou revis&#227;o cr&#237;tica de conte&#250;do intelectual importante&#59; Obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; Participa&#231;&#227;o efetiva na orienta&#231;&#227;o da pesquisa&#59; Participa&#231;&#227;o intelectual em conduta proped&#234;utica e&#47;ou terap&#234;utica de casos estudados&#59; Revis&#227;o cr&#237;tica da literatura&#59; Aprova&#231;&#227;o da vers&#227;o final do manuscrito&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">Wei Li&#58; Obten&#231;&#227;o de dados&#44; ou an&#225;lise e interpreta&#231;&#227;o dos dados&#59; an&#225;lise estat&#237;stica&#59; Obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; Participa&#231;&#227;o intelectual em conduta proped&#234;utica e&#47;ou terap&#234;utica de casos estudados&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">Guangsheng Wu&#58; Obten&#231;&#227;o de dados&#44; ou an&#225;lise e interpreta&#231;&#227;o dos dados&#59; An&#225;lise estat&#237;stica&#59; obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; Participa&#231;&#227;o intelectual em conduta proped&#234;utica e&#47;ou terap&#234;utica de casos estudados&#46;</p></span><span id="sec0140" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0180">Conflito de interesses</span><p id="par0170" class="elsevierStylePara elsevierViewall">Nenhum&#46;</p></span></span>"
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    "fechaRecibido" => "2023-06-03"
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            0 => "Dermatite at&#243;pica"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Fundamentos</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">O tratamento da dermatite at&#243;pica &#40;DA&#41; tem sido foco de pesquisas cl&#237;nicas e a interven&#231;&#227;o comportamental &#233; considerada m&#233;todo de tratamento indispens&#225;vel&#46; Que seja de conhecimento dos autores&#44; nenhuma metan&#225;lise relevante avaliou os efeitos de interven&#231;&#245;es comportamentais na DA&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objetivos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Avaliar os efeitos de interven&#231;&#245;es comportamentais na DA&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">M&#233;todos</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Foi realizada pesquisa nas bases de dados PubMed&#44; EMBASE e Cochrane Central para recuperar ensaios controlados randomizados &#40;ECR&#41; relevantes &#40;at&#233; fevereiro de 2022&#41;&#46; A estrat&#233;gia de busca envolveu combina&#231;&#227;o de palavras&#8208;chave relacionadas&#46; As estat&#237;sticas Cochrane Q e I<span class="elsevierStyleSup">2</span> foram utilizadas para avaliar a heterogeneidade&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Resultados</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Foram inclu&#237;dos seis ECR envolvendo sete artigos com 246 pacientes&#46; Os resultados sugeriram que as interven&#231;&#245;es comportamentais podem aliviar significantemente a gravidade do eczema &#40;coeficiente de correla&#231;&#227;o &#91;r<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#44;39&#93;&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; e a gravidade da escoria&#231;&#227;o &#40;r<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#44;19&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;017&#41;&#44; embora n&#227;o afetem a intensidade do prurido &#40;r<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#44;02&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;840&#41;&#46; A an&#225;lise de sensibilidade confirmou a robustez do resultado&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Limita&#231;&#245;es do estudo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Uma importante limita&#231;&#227;o desse estudo foi o n&#250;mero insuficiente de ECR e o tamanho limitado da amostra&#46; Al&#233;m disso&#44; o estudo n&#227;o tinha grupo controle que recebesse interven&#231;&#227;o diferente do protocolo experimental&#46; Outra limita&#231;&#227;o foi a curta dura&#231;&#227;o do seguimento&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conclus&#245;es</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Este estudo sugere que interven&#231;&#245;es comportamentais podem ser eficazes no tratamento da DA&#44; reduzindo a gravidade do eczema e da escoria&#231;&#227;o&#46; Al&#233;m disso&#44; a terapia comportamental de revers&#227;o de h&#225;bitos pode ser mais eficaz no tratamento dessa doen&#231;a&#46;</p></span>"
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          "pt" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Avalia&#231;&#227;o do risco de vi&#233;s dos estudos inclu&#237;dos&#46; Nesta figura&#44; Q1 a Q7 representam gera&#231;&#227;o de sequ&#234;ncia aleat&#243;ria&#44; oculta&#231;&#227;o de aloca&#231;&#227;o&#44; cegamento de participantes e pessoal&#44; cegamento da avalia&#231;&#227;o de resultados&#44; dados de resultados incompletos&#44; relato seletivo de desfechos e outros vieses&#44; respectivamente&#46;</p>"
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          "pt" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Metan&#225;lise do tamanho do efeito de interven&#231;&#245;es psicol&#243;gicas para reduzir a gravidade da escoria&#231;&#227;o&#46; IC&#44; intervalo de confian&#231;a&#46;</p>"
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          "leyenda" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">ADAM&#44; <span class="elsevierStyleItalic">Atopic Dermatitis Assessment Measure</span>&#59; CMU&#44; cuidados m&#233;dicos usuais&#59; ED&#44; educa&#231;&#227;o dermatol&#243;gica&#59; N&#46;R&#46;&#44; n&#227;o relatado&#59; SCORAD&#44; <span class="elsevierStyleItalic">Scoring Atopic Dermatitis</span>&#59; TC&#44; terapia comportamental&#46;</p>"
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                  <table border="0" frame="\n
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                  \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">Estudo&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" scope="col" style="border-bottom: 2px solid black">Pa&#237;s&nbsp;\t\t\t\t\t\t\n
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                  \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">Ambiente do estudo&nbsp;\t\t\t\t\t\t\n
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                  \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">Desenho&nbsp;\t\t\t\t\t\t\n
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                  \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">Tamanho amostral&nbsp;\t\t\t\t\t\t\n
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                  \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">M&#233;dia de idade&#44; anos&nbsp;\t\t\t\t\t\t\n
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                  \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">Porcentagem do g&#234;nero feminino&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">Dura&#231;&#227;o da doen&#231;a&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">Dura&#231;&#227;o do tratamento&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">N&#250;mero de sess&#245;es&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">Seguimento&nbsp;\t\t\t\t\t\t\n
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                  \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">Avalia&#231;&#227;o de resultados&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" 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">Ehlers 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">Alemanha</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">Base cl&#237;nica</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">CMU&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&#44;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&#44;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 semanas</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 semanas</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">Avalia&#231;&#227;o do m&#233;dico</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 " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ED&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&#44;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&#44;3&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 " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">TC&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&#44;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&#44;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 " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ED&#43;TC&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&#44;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&#44;2&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  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Habib 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">Austr&#225;lia</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">Base populacional</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">CMU&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&#44;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&#44;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 semanas</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 semanas</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-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">TC&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&#44;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&#44;1&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  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Melin 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">Su&#233;cia</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">Base cl&#237;nica</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">CMU&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&#44;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 semanas</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 semanas</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">Avalia&#231;&#227;o do m&#233;dico</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 " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">TC&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" 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">Noren 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">Su&#233;cia</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">Base cl&#237;nica</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">CMU&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&#44;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 semanas</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 semanas</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">Avalia&#231;&#227;o do m&#233;dico</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 " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">TC&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" 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">Schut 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">Alemanha</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">Base populacional</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">CMU&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&#44;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 semanas</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 semanas</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-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">TC&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&#44;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" 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">Noren 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">Su&#233;cia</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">Base populacional</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">CMU&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&#44;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 semanas</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 semanas</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-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">TC&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
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