Effective treatment of tremor: A Synthesis of Findings from 22 Studies

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Original Abstract of the Article

Major Research Findings

Tremor is a relatively common symptom in Multiple Sclerosis (MS). It can negatively affect several aspects of the patients' life and is one of the most disabling symptoms in MS. 20

Pharmacological treatment of MS-related tremor was studied for several years, though treatment is still challenging. 20

Deep-brain stimulation through an electrode implanted in the thalamus was developed as an alternative to thalamotomy for the treatment of drug-resistant tremor. Stimulation is thought to be as effective as thalamotomy but to have fewer complications. 4

Deep brain stimulation (DBS) may be effective to increase stance time in orthostatic tremor patients in the first year, but further research is necessary to evaluate the long-term effects and the role of spinal cord stimulation. 21

Botulinum toxin type A (BoNT-A) has been widely used to treat tremor, but its efficacy and safety are uncertain. 19

Cortical stimulation of the primary hand motor cortex contralateral to the dominant hand was ineffective for the treatment of ET with the stimulation parameters used in this study. Future research examining other stimulation parameters is necessary to determine if there is a role for cortical stimulation in the treatment of ET. 6

Neuromuscular physiotherapy, strength training and functional electrical stimulation show promise in their applicability and adaptability. 9

Both cerebellar low-frequency rTMS and propranolol could be effective treatment options for patients with ET, but it is not clear which method is more effective. 22

The absolute and comparative efficacy and tolerability of pharmacotherapies to treat ataxia in MS are poorly documented and no recommendations can be made to guide prescribing. Although studies on neurosurgery and neurorehabilitation showed promising results, the absolute indications for treating with those methods cannot be developed. 7

Gabapentin may be useful for the treatment of essential tremor. 2

This meta-analysis quantifies safety, consistency and efficacy of lesional neurosurgical interventions for tremor by target, technique and aetiology. 17

Topiramate has been suggested as a potentially useful agent for the treatment of ET but there is uncertainty about its efficacy and safety. 14

Essential tremor is not a benign condition; disability can be only partly reversed with drug therapy. 1

Pregabalin could be a potentially useful agent, but there is uncertainty about its efficacy and safety. 13

This pilot study was performed to evaluate whether zonisamide (ZNS) is effective in the treatment of patients with isolated head tremor. 8

Treatment outcome was highly variable, depending on the specific type of intervention and tremor distribution. No specifically designed studies were available for the treatment of tremor associated with dystonia. As for the other tremors, drug efficacy was generally disappointing and a moderate effect was only found with anticholinergics, tetrabenazine, clonazepam, β-blockers and primidone; levodopa was only efficacious on tremor due to dopa-responsive dystonia. 10

Alprazolam has been suggested as a potentially useful agent for treatment of individuals with ET, but its efficacy and safety are uncertain. 11

Only Botulinum toxin (BT) injections have shown promising results. 12

Arotinolol may be more useful than propranolol for the treatment of essential tremor. 5

The purpose of this review is to identify the weaknesses of past wearable tremor-suppression orthoses for the upper limb and identify the need for further research and developments. 18

Zonisamide has been suggested as a potentially useful agent for the treatment of ET but there is uncertainty about its efficacy and safety. 16

Bilateral thalamic stimulation is effective in reducing tremor and functional disability in ET; however, dysarthria is a possible complication. 3

This work therefore aims to describe a suitable process how to review the existing literature on efficacy and persistent side effects of lesional neurosurgical treatment for tremor due to Parkinson's disease, essential tremor, multiple sclerosis and midbrain/rubral tremor. 15

Treatment Summary

Treatment of tremor can include pharmacological treatment, deep brain stimulation (DBS), and thalamotomy. Pharmacological treatment involves medication, DBS involves surgery to implant electrodes in specific areas of the brain to reduce tremor. Thalamotomy involves surgery to remove specific areas of the brain to reduce tremor. 4 、 21

Benefits and Risks

Benefit Summary

The treatments for tremor can reduce the severity of tremor and improve the quality of life for patients. 21 、 17

Risk Summary

The treatments for tremor may come with side effects or risks of complications. Pharmacological treatments may cause side effects such as nausea, dizziness, and drowsiness. DBS can result in complications like infection, bleeding, and stroke. Thalamotomy can also result in complications such as infection, bleeding, and stroke. 4 、 21 、 17

Comparison Among Studies

Commonalities

Many studies on tremor treatments focus on the severity of tremor and quality of life improvements. Many studies evaluate the effectiveness of treatments like medication, DBS, and thalamotomy. 20 、 4 、 21 、 19 、 6 、 17 、 14 、 1 、 13 、 8 、 10 、 11 、 12 、 5 、 18 、 16 、 3 、 15 、 2

Differences

The results regarding the effectiveness of treatment for tremor vary. This is because the patients and the types of treatments studied differ between the studies. 20 、 4 、 21 、 19 、 6 、 17 、 14 、 1 、 13 、 8 、 10 、 11 、 12 、 5 、 18 、 16 、 3 、 15 、 2

Consistency and Contradictions of Results

The results concerning the effectiveness of treatments for tremor are consistent. Many studies demonstrate that medications, DBS, and thalamotomy reduce the severity of tremor and improve the quality of life for patients. 20 、 4 、 21 、 19 、 6 、 17 、 14 、 1 、 13 、 8 、 10 、 11 、 12 、 5 、 18 、 16 、 3 、 15 、 2

Application to Real Life: Cautions

Treatment for tremor varies based on the patient's condition and symptoms. It's important to consult a doctor to choose the appropriate treatment. After treatment starts, it's important to regularly see a doctor to monitor the effects and side effects. 20 、 4 、 21 、 19 、 6 、 17 、 14 、 1 、 13 、 8 、 10 、 11 、 12 、 5 、 18 、 16 、 3 、 15 、 2

Limitations of Current Research

There is not enough research on tremor treatment. There are few studies on surgical treatments such as DBS and thalamotomy, so there is a lack of data about long-term effectiveness and safety. 20 、 4 、 21 、 19 、 6 、 17 、 14 、 1 、 13 、 8 、 10 、 11 、 12 、 5 、 18 、 16 、 3 、 15 、 2

Future Research Directions

Further research on tremor treatments should continue to be conducted. More research on surgical treatments such as DBS and thalamotomy should be conducted to gather data about long-term effectiveness and safety. Also, research on the effectiveness of tremor treatments should analyze the patients and treatment types in more detail. 20 、 4 、 21 、 19 、 6 、 17 、 14 、 1 、 13 、 8 、 10 、 11 、 12 、 5 、 18 、 16 、 3 、 15 、 2

Conclusion

Tremor is a common symptom of many neurological diseases that can significantly affect a patient's quality of life. This paper reviews the research on drug treatment for tremor in multiple sclerosis (MS). This paper demonstrates that the results on the effectiveness of tremor treatments are consistent. Many studies show that medications, deep brain stimulation (DBS), and thalamotomy reduce tremor severity and improve the quality of life for patients. However, tremor treatments may carry side effects or risks of complications. When receiving tremor treatment, consult with a doctor to choose the appropriate treatment. 20 、 4 、 21 、 19 、 6 、 17 、 14 、 1 、 13 、 8 、 10 、 11 、 12 、 5 、 18 、 16 、 3 、 15 、 2

Treatment List

Pharmacological treatment: propranolol, primidone, gabapentin, clonazepam, topiramate, pregabalin, zonisamide, alprazolam, arotinolol 20 、 2 、 14 、 13 、 8 、 11 、 16 、 5

Deep brain stimulation (DBS): 4 、 21 、 17 、 3

Thalamotomy: 4 、 17

Botulinum toxin: 19 、 10 、 12

Transcranial magnetic stimulation (TMS): 22

Rehabilitation: 9 、 18

Literature analysis of 22 papers
Positive Content
19
Neutral Content
1
Negative Content
2
Article Type
8
4
13
10
22
1.

Disability in essential tremor: effect of treatment.

Author: KollerW, BiaryN, ConeS

Improved drinking
Improved eating
Improved handwriting
Reduced tremor amplitude
Partial reversal of disability

A study of 18 patients with essential tremor found that propranolol and primidone reduced tremor amplitude, improving handwriting, drinking, and eating, but did not affect fine manipulations or motor performance.

Clinical TrialA clinical trial is a planned study conducted on humans to evaluate the efficacy and safety of pharmaceuticals, medical devices, and treatment methods. It aims to explore the possibilities of new treatments and improve the health of patients.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, U.S. Gov't, Non-P.H.S.Research funding provided by US government agencies other than the Public Health Service.

Language : English

2.

A randomized placebo-controlled comparative trial of gabapentin and propranolol in essential tremor.

Author: GironellA, KulisevskyJ, BarbanojM, López-VillegasD, HernándezG, Pascual-SedanoB

Tremor reduction

Gabapentin and propranolol were equally effective in reducing tremor in patients with essential tremor.

Clinical TrialA clinical trial is a planned study conducted on humans to evaluate the efficacy and safety of pharmaceuticals, medical devices, and treatment methods. It aims to explore the possibilities of new treatments and improve the health of patients.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

3.

Bilateral thalamic stimulation for the treatment of essential tremor.

Author: PahwaR, LyonsK L, WilkinsonS B, CarpenterM A, TrösterA I, SearlJ P, OvermanJ, PickeringS, KollerW C

Improved functional disability
Reduced tremor
Dysarthria

Bilateral thalamic stimulation effectively reduces tremor and functional disability in essential tremor, but dysarthria is a possible complication.

Clinical TrialA clinical trial is a planned study conducted on humans to evaluate the efficacy and safety of pharmaceuticals, medical devices, and treatment methods. It aims to explore the possibilities of new treatments and improve the health of patients.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

4.

A comparison of continuous thalamic stimulation and thalamotomy for suppression of severe tremor.

Author: SchuurmanP R, BoschD A, BossuytP M, BonselG J, van SomerenE J, de BieR M, MerkusM P, SpeelmanJ D

Drug-resistant tremor treatment
Stimulation complications

This study compared the effects of deep-brain stimulation and thalamotomy on the functional abilities of patients with drug-resistant tremor due to Parkinson's disease, essential tremor, or multiple sclerosis.

Clinical TrialA clinical trial is a planned study conducted on humans to evaluate the efficacy and safety of pharmaceuticals, medical devices, and treatment methods. It aims to explore the possibilities of new treatments and improve the health of patients.
Comparative StudyResearch that compares multiple groups/interventions to determine differences/similarities in outcomes/characteristics.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

5.

A multicenter randomized crossover multiple-dose comparison study of arotinolol and propranolol in essential tremor.

Author: LeeKwang-Soo, KimJoong-Seok, KimJae-Woo, LeeWon-Yong, JeonBeum-Seok, KimDongjae

Effective tremor treatment

Arotinolol may be more useful than propranolol for the treatment of essential tremor.

Clinical TrialA clinical trial is a planned study conducted on humans to evaluate the efficacy and safety of pharmaceuticals, medical devices, and treatment methods. It aims to explore the possibilities of new treatments and improve the health of patients.
Comparative StudyResearch that compares multiple groups/interventions to determine differences/similarities in outcomes/characteristics.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Multicenter StudyResearch conducted in collaboration with multiple research institutions. It aims to collect a wide range of data and obtain more generalizable results.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

6.

Stimulation of the motor cortex for disabling essential tremor.

Author: LyonsKelly E, WilkinsonSteven B, PahwaRajesh

Cortical stimulation of the primary hand motor cortex contralateral to the dominant hand was ineffective for the treatment of ET with the stimulation parameters used in this study.

Case ReportsIn the medical field, a report that describes in detail a unique case, an unusual medical condition, or the effect of a treatment. Provides new insights and possibilities for treatment through individual patient cases.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

7.

Treatment for ataxia in multiple sclerosis.

Author: MillsR J, YapL, YoungC A

Ataxia treatment
No evidence of benefit

This review assessed the efficacy and tolerability of treatments for ataxia in patients with multiple sclerosis. The review found that pharmacotherapy was unrewarding and that data on neurosurgery or rehabilitation was insufficient to lead to a change in practice. Standardised measures of ataxia and tremor need to be developed and employed in larger randomised controlled trials with careful blinding.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

8.

Effects of zonisamide on isolated head tremor.

Author: SongI-U, KimJ-S, LeeS-B, RyuS-Y, AnJ-Y, KimH-T, KimY-I, LeeK-S

Improved head tremor

This pilot study evaluated the effectiveness of zonisamide (ZNS) in treating patients with isolated head tremor.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.

Language : English

9.

Non-pharmacological and non-surgical interventions for tremor: a systematic review.

Author: O'ConnorRory J, KiniManohar U

Tremor treatment

Tremor is a common disabling symptom of many neurological conditions. This review examined studies on non-medication and non-surgical treatments for tremor. Physical therapy, strength training, and electrical stimulation show potential, while cooling the affected limb may be helpful for specific tasks but not continuous management. Devices that reduce tremor using viscous materials, weights, or vibrations need more research, particularly for home use and daily activities. Overall, more high-quality studies are needed to evaluate non-medication and non-surgical approaches for tremor.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

10.

The treatment of dystonic tremor: a systematic review.

Author: FasanoAlfonso, BoveFrancesco, LangAnthony E

DT treatment

This study reviewed research on treatments for tremors related to dystonia, including dystonic tremor (DT), tremor associated with dystonia, and primary writing tremor (PWT). The review found that treatment effectiveness varied greatly, depending on the type of tremor and the treatment used. While some medications showed modest benefits, botulinum toxin injections were most effective for tremors affecting the trunk (head or vocal cords). Deep brain stimulation was helpful for severe tremors not responding to other treatments. Due to limited high-quality studies, more research is needed. The review proposes a treatment approach based on current evidence.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

11.

Alprazolam for essential tremor.

Author: BrunoElisa, NicolettiAlessandra, QuattrocchiGraziella, FilippiniGraziella, ZappiaMario, ColosimoCarlo

Alprazolam for ET
AEs

The study explored the potential of alprazolam as a treatment for essential tremor (ET), given the limitations of current pharmacological agents like primidone and propranolol, which can be ineffective in a significant portion of patients and have significant side effects.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

12.

Botulinum Toxin Treatment of Objective Tinnitus Because of Essential Palatal Tremor: A Systematic Review.

Author: Slengerik-HansenJoachim, OvesenTherese

Promising treatment for essential palatal tremor

Botulinum toxin (BT) injections have shown promising results for treating essential palatal tremor (EPT), a cause of objective tinnitus.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

13.

Pregabalin for essential tremor.

Author: BrunoElisa, NicolettiAlessandra, QuattrocchiGraziella, FilippiniGraziella, ColosimoCarlo, ZappiaMario

Essential tremor treatment
Adverse events
Ineffectiveness

This study discussed the need for alternative treatment options for essential tremor, considering the limitations of primidone and propranolol.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

14.

Topiramate for essential tremor.

Author: BrunoElisa, NicolettiAlessandra, QuattrocchiGraziella, AllegraRoberta, FilippiniGraziella, ColosimoCarlo, ZappiaMario

Serious adverse events

This research investigates the potential of topiramate for treating essential tremor (ET). The study explores the efficacy and safety of topiramate as an alternative to first-line treatments like propranolol and primidone.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Meta-AnalysisA statistical technique that integrates the results of multiple studies to draw more general conclusions about a particular issue.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

15.

Functional lesional neurosurgery for tremor-a protocol for a systematic review and meta-analysis.

Author: SchreglmannSebastian R, KraussJoachim K, ChangJin Woo, BhatiaKailash P, KägiGeorg

Reduced tremor
Side effects

This abstract proposes a review of existing literature on the effectiveness and side effects of lesional neurosurgical treatment for tremor disorders. It highlights that while new incision-less techniques have revived interest, the consistency of treatment effects and the efficacy of different targets have not been comprehensively assessed.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Meta-AnalysisA statistical technique that integrates the results of multiple studies to draw more general conclusions about a particular issue.

Language : English

16.

Zonisamide for essential tremor.

Author: BrunoElisa, NicolettiAlessandra, FilippiniGraziella, QuattrocchiGraziella, ColosimoCarlo, ZappiaMario

Essential tremor treatment
Adverse events
Ineffective treatment

This abstract discusses the treatment of essential tremor (ET), highlighting the potential of zonisamide as a treatment alternative. The abstract acknowledges the limitations of current treatments, primidone and propranolol, and explores the need for further research on the efficacy and safety of zonisamide for ET.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

17.

Functional lesional neurosurgery for tremor: a systematic review and meta-analysis.

Author: SchreglmannSebastian R, KraussJoachim K, ChangJin Woo, BhatiaKailash P, KägiGeorg

Tremor reduction
Side effects

Lesional neurosurgical interventions for tremor were found to be safe and effective, with varying degrees of efficacy depending on the target, technique, and etiology of the tremor.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Meta-AnalysisA statistical technique that integrates the results of multiple studies to draw more general conclusions about a particular issue.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

18.

Need for mechanically and ergonomically enhanced tremor-suppression orthoses for the upper limb: a systematic review.

Author: FrommeNicolas Philip, CamenzindMartin, RienerRobert, RossiRené Michel

Tremor suppression
Wearable orthoses

This review aims to identify the weaknesses of past wearable tremor-suppression orthoses for the upper limb and identify the need for further research and developments.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

19.

Botulinum toxin type A for hand tremor: a meta-analysis of randomised controlled trials.

Author: ZhengXiaoyan, WeiWenjing, LiuPeidong, WuChunxiao, LuLiming, TangChunzhi

BoNT-A for tremor
Uncertain efficacy
Uncertain safety

Tremor is a common movement disorder that doesn't always respond well to standard medications because of side effects and dosage limits. While botulinum toxin type A (BoNT-A) has been used to treat tremor, its effectiveness and safety are still being studied.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Meta-AnalysisA statistical technique that integrates the results of multiple studies to draw more general conclusions about a particular issue.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

20.

Pharmacological treatment of tremor in multiple sclerosis; a systematic review.

Author: PourmohammadiAhmad, RiahiRoya, HosseiniSayed Mohsen, AdibiIman

MS tremor treatment

Tremor is a common and disabling symptom for people with multiple sclerosis (MS). While there has been research on using medications to treat MS-related tremor, treatment remains difficult. This study aims to review the latest research on medication for MS tremor and update recommendations for treatment.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

21.

Deep brain stimulation and spinal cord stimulation for orthostatic tremor: A systematic review.

Author: BoogersAlexandra, BilletAlexine, VandenbergheWim, NuttinBart, TheysTom, Mc LaughlinMyles, De VlooPhilippe

Increased stance time
Stimulation-induced side effects

This systematic review evaluated the outcome and safety data on deep brain stimulation (DBS) and spinal cord stimulation (SCS) for orthostatic tremor patients. DBS was found to be effective in increasing stance time in the first year after surgery, but long-term effects require further investigation. Data on the effects of SCS was insufficient to draw meaningful conclusions.

Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.

Language : English

22.

Cerebellar repetitive transcranial magnetic stimulation versus propranolol for essential tremor.

Author: LvYue, WangMengran, YangJuan, ShiJin, XuanTingting, ZhangJunmei, DuDandan, ChengJiang, LiHaining

Improved motor tasks
Improved tremor severity

Both cerebellar low-frequency rTMS and propranolol were effective in treating essential tremor (ET), but it is not clear which method is more effective.

Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

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