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Pooled analysis indicated a statistically significant reduction of anxiety scores with the use of media distraction (MD -3.91; 95% CI -6.44, -1.38; I2=77.7%). To conclude, the present review suggests that media distraction in the form of AV media or music may be beneficial in reducing the pain and anxiety of patients undergoing ESWL. Evidence is, however, weak considering the small effect size, confidence intervals being close to zero, and instability of the results on sensitivity analysis. In clinical practice, media distraction may be