Clinical trials of meditation practices in health care: Characteristics and quality

Objective: To provide a descriptive overview of the clinical trials assessing meditation practices for health care. Design: Systematic review of the literature. Comprehensive searches were conducted in 17 electronic bibliographic databases through September 2005. Other sources of potentially relevant studies included hand searches, reference tracking, contacting experts, and gray literature searches. Included studies were clinical trials with 10 or more adult participants using any meditation practice, providing quantitative data on health-related outcomes, and published in English. Two independent reviewers assessed study relevance, extracted the data, and assessed the methodological quality of the studies. Results: Four hundred clinical trials on meditation (72% described as randomized) were included in the review (publication years 1956-2005). Five broad categories of meditation practices were identified: mantra meditation, mindfulness meditation, yoga, t'ai chi, and qigong. The three most studied clinical conditions were hypertension, miscellaneous cardiovascular diseases, and substance abuse. Psychosocial measures were the most frequently reported outcomes. Outcome measures of psychiatric and psychological symptoms dominate the outcomes of interest. Overall, the methodological quality of clinical trials is poor, but has significantly improved over time by 0.014 points every year (95% CI, 0.005, 0.023). Conclusions: Most clinical trials on meditation practices are generally characterized by poor methodological quality with significant threats to validity in every major quality domain assessed. Despite a statistically significant improvement in the methodological quality over time, it is imperative that future trials on meditation be rigorous in design, execution, analysis, and the reporting of results.