The basis of their effectiveness lies in timing the bullet exit to barrel movement. You want the bullet to exit when the barrel is moving up. Slower than average bullets exit later with the barrel pointing higher to compensate for their lower velocity. Fast bullets exit sooner with the barrel pointing lower to compensate for their higher velocity. When you adjust the position and weight of the tuner you change the barrel movement and timing.
The shooter has no way of determining what the attitude of the barrel is. Testing may show several nodes and the idea is to choose the largest node which will be the most forgiving with the adjustment range.
No, they do not have a huge effect, but to a target shooter in competition shooting at the limit of the best ammo it can make the difference between winning and losing.