The relationship between mindfulness and objective measures of body awareness: A meta-analysis

Although awareness of bodily sensations is a common mindfulness meditation technique, studies assessing the relationship between mindfulness and body awareness have provided mixed results. The current study sought to meta-analytically examine the relationship between mindfulness operationalized as a dispositional trait or a construct trained through short- (i.e., randomized controlled trials [RCTs]) or long-term mindfulness meditation practice with objective measures of body awareness accuracy. PubMed, Web of Science, PsycINFO, and Scopus were searched. Studies were eligible if they reported the association between mindfulness and body awareness, were published in English, and included adults. Across 15 studies (17 independent samples), a small effect was found linking mindfulness with greater body awareness accuracy (g = 0.21 [0.08, 0.34], N = 879). When separated by study design, only RCTs continued to show a significant relationship (g = 0.20, [0.02, 0.38], k = 7, n = 505). Heterogeneity of effects was low (I2 < 25%), although with wide confidence intervals. Effects were not moderated by study quality. Low fail-safe N estimates reduce confidence in the observed effects. Results suggest a small but potentially detectable relationship between mindfulness and body awareness accuracy. Future investigations could examine individual differences in body awareness as a mechanism within mindfulness interventions.


Rationale
3 Describe the rationale for the review in the context of what is already known.

1-2
Objectives 4 Provide an explicit statement of questions being addressed with reference to participants, interventions, comparisons, outcomes, and study design (PICOS).

METHODS
Protocol and registration 5 Indicate if a review protocol exists, if and where it can be accessed (e.g., Web address), and, if available, provide registration information including registration number. 7 Eligibility criteria 6 Specify study characteristics (e.g., PICOS, length of follow-up) and report characteristics (e.g., years considered, language, publication status) used as criteria for eligibility, giving rationale.

7
Information sources 7 Describe all information sources (e.g., databases with dates of coverage, contact with study authors to identify additional studies) in the search and date last searched. 8 Search 8 Present full electronic search strategy for at least one database, including any limits used, such that it could be repeated.

8, Supp Materials
Study selection 9 State the process for selecting studies (i.e., screening, eligibility, included in systematic review, and, if applicable, included in the meta-analysis).
8 Data collection process 10 Describe method of data extraction from reports (e.g., piloted forms, independently, in duplicate) and any processes for obtaining and confirming data from investigators. 8 Data items 11 List and define all variables for which data were sought (e.g., PICOS, funding sources) and any assumptions and simplifications made.

8-9
Risk of bias in individual studies 12 Describe methods used for assessing risk of bias of individual studies (including specification of whether this was done at the study or outcome level), and how this information is to be used in any data synthesis.

9
Summary measures 13 State the principal summary measures (e.g., risk ratio, difference in means).

9-10
Synthesis of results 14 Describe the methods of handling data and combining results of studies, if done, including measures of consistency (e.g., I2) for each meta-analysis.

Section/topic # Checklist item Reported on page #
Risk of bias across studies 15 Specify any assessment of risk of bias that may affect the cumulative evidence (e.g., publication bias, selective reporting within studies).

10
Additional analyses 16 Describe methods of additional analyses (e.g., sensitivity or subgroup analyses, meta-regression), if done, indicating which were pre-specified.

RESULTS
Study selection 17 Give numbers of studies screened, assessed for eligibility, and included in the review, with reasons for exclusions at each stage, ideally with a flow diagram.

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Study characteristics 18 For each study, present characteristics for which data were extracted (e.g., study size, PICOS, follow-up period) and provide the citations.

2-3, 17-18
Risk of bias within studies 19 Present data on risk of bias of each study and, if available, any outcome level assessment (see item 12).

3, Supp Materials
Results of individual studies 20 For all outcomes considered (benefits or harms), present, for each study: (a) simple summary data for each intervention group (b) effect estimates and confidence intervals, ideally with a forest plot.

DISCUSSION
Summary of evidence 24 Summarize the main findings including the strength of evidence for each main outcome; consider their relevance to key groups (e.g., healthcare providers, users, and policy makers).

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Limitations 25 Discuss limitations at study and outcome level (e.g., risk of bias), and at review-level (e.g., incomplete retrieval of identified research, reporting bias).

4-6
Conclusions 26 Provide a general interpretation of the results in the context of other evidence, and implications for future research.

4-7 FUNDING
Funding 27 Describe sources of funding for the systematic review and other support (e.g., supply of data); role of funders for the systematic review. Joint kinesthesia Wooten 2018* Note: Tasks were defined as distal if they involved indirect measure of interoceptive accuracy (Garfinkel et al., 2015). All tasks fit inclusion criteria of 'correct and precise monitoring' (Khalsa & Lapidus, 2016). *These papers contained multiple body awareness accuracy measures, and reported effect sizes for proximal measures as well. Table 2. Modified Jadad coding of study quality