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Assessment of clinical effectiveness

Titles and, where available, abstracts of a total of 8954 records were screened and full copies of the 224 references were retrieved (because of resource limitations only references in English were selected for retrieval). After inspection of the retrieved references, 150 were excluded (see Appendix 6): 81 because they did not focus on the patient group of interest, two because the intervention was not relevant, 12 because they did not report the necessary outcomes, 62 were because of their design and four because they were abstracts containing insufficient information to judge study quality, methodology and results (references could be excluded for more than one reason). Seventy-four retrieved references/full papers describing 68 studies met the inclusion criteria of the review. The total number of records assessed at each stage of the systematic review screening process is shown in the flow chart of Figure 3.

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