Giles 1999.
| Methods | Type of trial: RCT Number analysed/randomly assigned: 98/157 for all spinal patients; 62/x for neck subgroup Intention‐to‐treat analysis: NR | |
| Participants | Chronic neck pain with degenerative changes | |
| Interventions | INDEX TREATMENT
Manipulation (A): technique: high‐velocity low‐amplitude manipulation; frequency: 6 sessions/median 19 days; dose: 15‐ to 20‐minute appointment; route: cervical spine COMPARISON TREATMENT Acupuncture (B): technique: 8 to 10 needles with low‐volt electrical stimulation to tender points; frequency: 6 sessions/median 40 days Medication (C): tenoxicam (NSAID) with ranitidine, median 15 days CO‐INTERVENTION: NR Duration of treatment: 3 to 4 weeks, 6 sessions Duration of follow‐up: none |
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| Outcomes | PAIN (neck pain change scores, VAS, 0 to 10) Baseline median: A 4.5, B 2.0, C 4.0 Absolute benefit: A 1.5, B 1.0, C 0.5 Reported results: not clear SMD (A vs C): ‐0.19 (95% CI ‐0.89 to 0.51) SMD (A vs B): ‐0.13 (95% CI ‐0.78 to 0.52) FUNCTION (NDI, 0 to 50) Baseline median: A 32, B 40, C 28 Absolute benefit: A 10.0, B 6.0, C 0.0 Reported results: not clear SMD (A vs C): ‐0.50 (95% CI ‐1.30 to 0.29) SMD (A vs B): ‐0.18 (95% CI ‐0.96 to 0.60) PATIENT SATISFACTION: NR GPE: NR QoL: NR SIDE EFFECTS: no side effects seen with acupuncture or manipulation COST OF CARE: NR |
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| Notes | ||
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Page 377, left column, paragraph 3 |
| Allocation concealment (selection bias) | Unclear risk | Not described |
| Blinding of Participants (performance bias) | High risk | Not possible owing to design |
| Blinding of Personal (performance bias) | High risk | Not possible owing to design |
| Blinding of the Outcome assessor (detection bias) | High risk | Not possible owing to design |
| Incomplete outcome data (attrition bias) | High risk | Page 378, left column, paragraph 2 |
| Randomized Participants analysed were allocated (attrition bias) | High risk | Numbers in Table 1 and Table 2 do not add up |
| Selective outcome (reporting bias) | Unclear risk | No reported protocol |
| Similar groups at baseline? | High risk | Table 1 |
| co‐interventions avoided or similar? | Unclear risk | Not described |
| Compliance acceptable? | Unclear risk | Not described |
| Similar timing of outcome assessment? | Low risk | Baseline, 4 weeks |