Supplemental Materials s3

SUPPLEMENTAL MATERIALS 52

Supplemental Materials

Effect of Kindness-Based Meditation on Health and Well-Being: A Systematic Review and Meta-Analysis

By J. Galante et al., Journal of Consulting and Clinical Psychology

http://dx.doi.org/10.1037/a0037249

Effect of Kindness-Based Meditation on Health and Wellbeing: a Systematic Review and Meta-Analysis

Supplemental Materials

Julieta Galante 1, Ignacio Galante 2, Marie-Jet Bekkers 3, John Gallacher 1

1 Cochrane Institute of Primary Care and Public Health, Cardiff University

2 School of Medicine, University of Buenos Aires

3 TIME Institute, Cardiff University

Correspondence concerning this article should be addressed to Julieta Galante, Cochrane Institute of Primary Care and Public Health, Cardiff University, 5th Floor, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4XN, United Kingdom. E-mail:

SUPPLEMENTAL MATERIALS 52

Tables

Table S1

Excluded Records That Were Close to Meeting the Eigibility Criteria

Reason / Study(s)
Not adults / (Pace et al., 2013; Reddy et al., 2013)
Not a RCT / (Boellinghaus, 2011; Brewer et al., 2011; Colzato, 2012; Engstrom, 2010; David P. Johnson et al., 2011; D. P. Johnson et al., 2009; M. B. Johnson, 2012; Klimecki, 2012; Lee et al., 2012; Leiberg, Klimecki, & Singer, 2011; Leppma, 2011; Leung et al., 2012; A. Lutz, Brefczynski-Lewis, Johnstone, & Davidson, 2008; A. Lutz, Greischar, Perlman, & Davidson, 2009; A. G. Lutz, L. L.; Rawlings, N. B.; Ricard, M.; Davidson, R. J., 2004; C. J. May et al.; Pace et al., 2010; Pryor, 2011; S. Sears & Kraus, 2009; S. R. Sears, Kraus, Carlough, & Treat, 2011; Sweet & Johnson, 1990; Tonelli, 2012; Walker, 2006; Wong, 2011)
Studies effects on recipient of kindness-based meditation, not practitioner / (Kemper & Shaltout, 2011; Shaltout, Tooze, Rosenberger, & Kemper, 2012)
Meditation but not predominantly kindness-based / (Carlson, Bacaseta, & Simanton, 1988; Lo, 2011; Oman, Shapiro, Thoresen, Plante, & Flinders, 2008; Oman, Thoresen, & Hedberg, 2010; Richards & Martin Jr, 2012)
Kindness-based intervention but not predominantly meditation / (A.C. Kelly, 2012; A. C. Kelly, Zuroff, Foa, & Gilbert, 2010; Lincoln, Hohenhaus, & Hartmann, 2012; M. May, 2005; Rein, Atkinson, & McCraty, 1995; Standard, 2004)
No outcomes related to health or wellbeing / (Barnhofer, Chittka, Nightingale, Visser, & Crane, 2010)

SUPPLEMENTAL MATERIALS 52

Table S2

Risk-of-Bias Assessment

Study (main publication) / Random sequence generation / Allocation concealment / Blinding of participants and staff / Blinding of outcome assessment / Incomplete outcome data / Selective reporting / Other sources of bias /
(Humphrey, 1999) / Low risk / Low risk / High risk/unclear risk / High risk / Unclear risk / Unclear risk / Unclear risk
"Thirteen slips of paper with "NOW' written on each, and 13 slips of paper with "LATE" written on each were put into a coffee can and mixed up thoroughly. Each participant attending the meeting drew from the can." / "Thirteen slips of paper with "NOW' written on each, and 13 slips of paper with "LATE" written on each were put into a coffee can and mixed up thoroughly. Each participant attending the meeting drew from the can." / Participants & intervention providers: nature of intervention impairs blinding. Staff: not specified. / Self-reported outcomes by unblinded participants. / Unbalanced attrition (18% in intervention group & 8% in waitlist), reasons not given. / All outcomes listed in the 'methods' section are reported, but no study protocol was found. / No ITT analysis. No baseline measures comparison between the intervention and control groups.
(Carson et al., 2005) / Low risk / Low risk / High risk/Low risk / High risk / Unclear risk / Unclear risk / Unclear risk
"Assignments were generated by an individual not involved in the study using a random number table." / "Assignments were concealed in envelopes that were not opened until the patient was randomized". Envelopes were opaque, sealed and sequentially numbered. * / Participants & intervention providers: nature of intervention impairs blinding. Staff: "The research assistant collecting battery data was kept blind with regard to patient condition assignments". / Self-reported outcomes by unblinded participants. / Unbalanced attrition (42% in the intervention group, 17% in standard care). Reasons unavailable due to an administrative error. * / All outcomes listed in the 'methods' section are reported, but there is no publicly available study protocol. * / No ITT analysis. Baseline imbalance present but post hoc analyses indicated that it was not related to study results.
(Williams et al., 2005) / Low risk / Unclear risk / High risk/Low risk / High risk / Low risk/Unclear risk / Unclear risk / High risk
"SAS version 8.2 ... assigned participants to a balanced randomization" "The participants were blocked randomized using sequential numbers" * / Not specified. / Participants & intervention providers: nature of intervention impairs blinding. Staff: "A research associate who was blinded to intervention assignment and who had no other contact with the residents administered the MVQOLI". / Self-reported outcomes by unblinded participants. / Unbalanced attrition (46% LKM, 0% combined group, 44% massage and 25% control group). Combined group had significantly better baseline health. "There were no adverse events associated with any of the interventions." Greater unknown attrition for follow-up. / All outcomes listed in the 'methods' section are reported, but no study protocol was found. / ITT analysis with last observation carried forward, a potentially biased method for the terminally ill. Block randomization. Unbalanced distribution of baseline variables probably due to small numbers.
(Templeton, 2007) / Unclear risk / Unclear risk / Unclear risk / Unclear risk / Low risk / High risk / Unclear risk
"Participants were tested in groups of four and were randomly assigned to individual rooms corresponding to one of four conditions..." / Not specified. / Participants with no previous contact with meditation could have been blinded due to short intervention and similarity to control. Staff: not specified. / Self-reported outcomes by potentially blinded participants. / No missing outcome data. / Not all outcomes listed in the 'methods' section are reported. No study protocol was found. / ITT analysis. No baseline measures comparison between the intervention and control groups.
(Weibel, 2007 ) / Low risk / Low risk / High risk/unclear risk / High risk / Unclear risk / Unclear risk / Unclear risk
"As each participant handed in their surveys they were handed a randomly sorted card which indicated whether they were in the intervention or control group." / "I randomly assigned them to groups by giving them 1 of 2 numbers, that I could not see. After they were in the group, I recorded group, so I was not blind anymore." * / Participants & intervention providers: nature of intervention impairs blinding. Staff: not specified. / Self-reported outcomes by unblinded participants. / Moderate attrition (LKM: 8% ctrl: 15%, follow up: LKM: 11% ctrl: 21%), reasons unknown. Dropouts non-significantly different from completers on baseline measures. * / All outcomes listed in the 'methods' section are reported, but there is no publicly available study protocol. * / No ITT analysis. No significant differences in baseline measures between the intervention and control groups.
(Fredrickson, Cohn, Coffey, Pek, & Finkel, 2008) / Unclear risk / Unclear risk / High risk/unclear risk / High risk / Unclear risk / Unclear risk / Unclear risk
Not specified / Not specified / Participants & intervention providers: nature of intervention impairs blinding. Staff: not specified. / Self-reported outcomes by unblinded participants. / High but balanced attrition (33% in LKM & 29% in waitlist). Reasons partially addressed. Male participants were disproportionately lost to attrition but equally distributed between arms. / All outcomes listed in the 'methods' section are reported, but no study protocol was found. / ITT analysis but missing data management was not addressed. No baseline measures comparison between the intervention and control groups.
(Hutcherson, Seppala, & Gross, 2008) / Unclear risk / Unclear risk / Unclear risk / Unclear risk / Low risk / Unclear risk / Unclear risk
Not specified. / Not specified. / Participants with no previous contact with meditation could have been blinded due to short intervention and similarity to control. Staff: not specified. / Not specified. Self-reported outcomes by potentially blinded participants. / No missing outcome data. / All outcomes listed in the 'methods' section are reported, but no study protocol was found. / ITT analysis. No baseline measures comparison between the intervention and control groups.
(Pace et al., 2009) / Low risk / Low risk / High risk/Low risk / Low risk/High risk / Unclear risk / Unclear risk / Unclear risk
"Randomization was accomplished through the use of separate computer generated randomization lists for males and females." / "statistician provides research personnel with a series of sequentially numbered, sealed envelopes ..., each containing a unique assignment slot. These envelopes are opened in numerical order ... providing both subjects and the study coordinator with knowledge about group assignment at that time." * / Participants & intervention providers: nature of intervention impairs blinding. Staff: "We endeavour to blind all personnel involved in the post-intervention TSST", "All personnel involved in blood processing and conducting/ interpreting laboratory assays are blinded to group assignment." * / "We endeavor to blind all personnel involved in the post-intervention TSST", "All personnel involved in blood processing and conducting/ interpreting laboratory assays are blinded to group assignment." Some outcomes are self-reported by unblinded participants. * / High but balanced attrition (27% in CM & 36% in control). Reasons partially addressed. Dropouts non-significantly different from completers on baseline measures. / All outcomes listed in the 'methods' section are reported, but there is no publicly available study protocol. * / No ITT analysis. No significant differences in baseline measures between the intervention and control groups.
(Crane, Jandric, Barnhofer, & Williams, 2010) / Low risk / Low risk / High risk/unclear risk / High risk / Low risk / Unclear risk / Unclear risk
"allocation picked at random from the envelope for each consecutive participant." / "Randomization to groups was conducted through the use of pre-prepared envelopes containing allocations" Participants were from the general public and results were contrary to expectations. / Participants & intervention providers: nature of intervention impairs blinding. Staff: not specified. / Self-reported outcomes by unblinded participants. / No missing outcome data. / All outcomes listed in the 'methods' section are reported, but there is no publicly available study protocol. * / ITT analysis. No baseline measures comparison between the intervention and control groups.
(Feldman, Greeson, & Senville, 2010) / High risk / High risk / Unclear risk / Unclear risk / Low risk / Unclear risk / Low risk
All the participants attending to a session would be assigned to the same condition. Decision based on running enrolment totals, number of participants in that session and time of day. * / All the participants attending to a session would be assigned to the same condition. Decision based on running enrolment totals, number of participants in that session and time of day. * / Participants with no previous contact with meditation could have been blinded due to short intervention and similarity to control. Staff: not specified. / Self-reported outcomes by potentially blinded participants. / No missing outcome data. / All outcomes listed in the 'methods' section are reported, but there is no publicly available study protocol. * / ITT analysis. No significant differences in baseline measures between the intervention and control groups.
(Kleinman, 2010) / Low risk / Low risk / High risk/Low risk / High risk / Low risk / Unclear risk / High risk
"Randomization was accomplished through the use of separate computer generated randomization lists for males and females." / "statistician provides research personnel with a series of sequentially numbered, sealed envelopes ..., each containing a unique assignment slot. These envelopes are opened in numerical order ... providing both subjects and the study coordinator with knowledge about group assignment ." * / Participants & intervention providers: nature of intervention impairs blinding. Staff: not specified but likely to have been done as part of bigger study. / Self-reported outcomes by unblinded participants. / No missing outcome data. / All outcomes listed in the 'methods' section are reported, but there is no publicly available study protocol. * / No ITT analysis. Baseline variables were not balanced among groups. Two outliers were dropped from the data.
(Desbordes et al., 2012) / Low risk / Low risk / High risk/Low risk / Low risk/High risk / Unclear risk / Low risk / Unclear risk
"Randomization was accomplished through the use of separate computer generated randomization lists for males and females." / "statistician provides research personnel with a series of sequentially numbered, sealed envelopes ..., each containing a unique assignment slot. These envelopes are opened in numerical order ... providing both subjects and the study coordinator with knowledge about group assignment at that time." * / Participants & intervention providers: nature of intervention impairs blinding. Staff: "We endeavor to blind all personnel involved in the post-intervention TSST", "All personnel involved in blood processing and conducting/ interpreting laboratory assays are blinded to group assignment." * / "We endeavor to blind all personnel involved in the post-intervention TSST", "All personnel involved in blood processing and conducting/ interpreting laboratory assays are blinded to group assignment." Some outcomes are self-reported by unblinded participants. * / Unbalanced attrition (CBCT 5%, MAT 27%, health discussion 27%). Reasons for dropping out not yet available: "These data are currently under review and should be available in by the end of Summer 2013" * / Protocol was found. Not all the outcomes mentioned in the protocol are reported but more publications are on the way. / No ITT analysis. No significant differences in baseline measures between the intervention and control groups.
(Hunsinger, Livingston, & Isbell, 2013) / High risk / High risk / High risk / High risk / Low risk / Unclear risk / Unclear risk
"Participants were assigned to conditions in blocks in terms of who signed up for particular time slots. We varied the time of day and day of the week during which data were collected for each block. For example, on Monday from 1-2pm anyone who signed up to participate in the experiment was assigned to meditation condition and from 2-3pm anyone who signed up was assigned to the control condition." * / "Participants were assigned to conditions in blocks in terms of who signed up for particular time slots. We varied the time of day and day of the week during which data were collected for each block. For example, on Monday from 1-2pm anyone who signed up to participate in the experiment was assigned to meditation condition and from 2-3pm anyone who signed up was assigned to the control condition." * / Participants & intervention providers: nature of intervention impairs blinding. Staff: "The people collecting data were not blinded to group allocation." / Self-reported outcomes by unblinded participants. * / Low attrition (0.2% LKM). Reasons not specified. / All outcomes listed in the 'methods' section are reported, but there is no publicly available study protocol. * / No ITT analysis. No baseline measures comparison between the intervention and control groups.