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Table 1 Summary of main findings comparing clowning and parental presence or no intervention

From: Clowning in children undergoing potentially anxiety-provoking procedures: a systematic review and meta-analysis

Clowning compared to parental presence or no intervention in children undergoing potentially anxiety-provoking procedures
Patient or population: children undergoing potentially anxiety-provoking procedures Setting: any setting Intervention: clowning Comparison: parental presence or no intervention
Outcomes Anticipated absolute effects* (95% CI) Relative effect (95% CI) № of participants (studies) Certainty of the evidence (GRADE) Comments
Risk with parental presence or no intervention Risk with clowning
Children’s anxiety during preoperative time Assessed with m-YPAS Scale: from 0 to 100 The mean children’s anxiety during preoperative time in the intervention group was 7.16 lower (10.58 lower to 3.75 lower) 183 (4 RCTs) Very lowa,b,c,d,e,f
Children’s anxiety in operation/induction/patient room Assessed with mYPAS Scale: from 0 to 100 The mean children’s anxiety in operation/induction/patient room in the intervention group was 20.45 lower (35.54 lower to 5.37 lower) 255 (5 RCTs) Very lowa,b,c,d,e,f,g
Children’s anxiety during mask application/physician examination Assessed with m-YPAS Scale: from 0 to 100 The mean children’s anxiety during mask application/physician examination in the intervention group was 2.33 higher (4.82 lower to 9.48 higher) 115 (2 RCTs) Very lowa,f,h,i,j
Children’s anxiety throughout process Assessed with m-YPAS Scale: from 0 to 100 The mean children’s anxiety throughout process in the intervention group was 13.8 lower (21.28 lower to 6.32 lower) 91 (1 RCT) Very lowa,c,d,f,i
Parental anxiety-state anxiety Assessed with STAI Y-1 Scale: from 20 to 80 The mean parental anxiety-state anxiety in the intervention group was 4 lower (6.35 lower to 1.65 lower) 278 (5 RCTs) Very lowa,b,c,d,e,f
Parental anxiety-trait anxiety Assessed with STAI Y-2 Scale: from 20 to 80 The mean parental anxiety-trait anxiety in the intervention group was 3.67 lower (6.65 lower to 0.69 lower) 231 (4 RCTs) Very lowa,b,c,d,e,f
Parental anxiety Assessed with VRS scale Scale: from 0 to 45 The mean parental anxiety in the intervention group was 1.4 lower (2.4 lower to 0.4 lower) 50 (1 RCT) Very lowa,c,d,e,f
Children’s pain Assessed with combined score of FPS-R and VAS The mean children’s pain in the intervention group was 5.3 lower (6.77 lower to 3.83 lower) 53 (1 RCT) Very lowa,b,e,f,j
Children’s cooperation Assessed with questionnaire and child observation form Scale: from 0 to 16 The mean children’s cooperation in the intervention group was 6.2 lower (8.64 lower to 3.76 lower) 50 (1 RCT) Very lowa,c,d,e,f,i
  1. *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI)
  2. CI confidence interval, MD mean difference
  3. GRADE Working Group grades of evidence
  4. High certainty: we are very confident that the true effect lies close to that of the estimate of the effect.
  5. Moderate certainty: we are moderately confident in the effect estimate. The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different.
  6. Low certainty: our confidence in the effect estimate is limited. The true effect may be substantially different from the estimate of the effect.
  7. Very low certainty: we have very little confidence in the effect estimate. The true effect is likely to be substantially different from the estimate of effect.
  8. aHigh risk of performance bias across the studies reporting this outcome
  9. bUnclear risk of attrition bias across the studies reporting this outcome
  10. cUnclear risk of reporting bias across the studies reporting this outcome
  11. dUnclear risk of selection bias across the studies reporting this outcome
  12. eHigh risk of detection bias across the studies reporting this outcome
  13. fSample size less than 400
  14. gConsiderable heterogeneity
  15. hUnclear risk of detection bias across the studies reporting this outcome
  16. iHigh risk of attrition bias across the studies reporting this outcome
  17. jHigh risk of reporting bias across the studies reporting this outcome