Randomised controlled trials (RCTs) and prospective controlled observational studies (for efficacy) or uncontrolled and retrospective observational studies with at least 30 participants (for safety) were eligible for inclusion. Studies had to compare Bach flower remedies against placebo in patients with pain and/or psychological symptoms in any setting and report pain reduction, symptom improvement and adverse events.
Studies that assessed efficacy of Bach flower remedies were conducted in UK, Germany, Israel and USA in students with examination anxiety or children with attention-deficit hyperactivity disorder (ADHD). Where reported, mean ages were 25.6 to 28 years for students and seven to 11 years for children. Treatment duration ranged from three hours to three months. Outcome measures were the State-Trait Anxiety Inventory (STAI) or S-anxiety subscale scores, Conner's scores or German Test Anxiety Inventory (TAI-G) score.
Studies were selected by two reviewers independently. Disagreements were resolved by consensus or involvement of a third reviewer.