Table 1.
Assessment of the certainty of evidence using GRADE for maternal and neonatal outcomes.
| Physical therapeutic assistance compared to usual care of the service for labor | ||||||||
|---|---|---|---|---|---|---|---|---|
| Patient or population: Women in labor | ||||||||
| Setting: Maternity | ||||||||
| Intervention: Physical therapy assistance | ||||||||
| Comparison: Usual care of the service | ||||||||
| Outcome № of participants (studies) |
Relative effect (95% CI) |
Anticipated absolute effects (95% CI) |
Certainty | What happens | ||||
| Difference | ||||||||
| Spontaneous vaginal delivery № of participants: 694 (9 RCTs) |
RR 1.10 (1.04, 1.17) |
78.7% |
86.5% (81.8, 92) |
7.9% more (3.1 more to 13.4 more) |
⨁⨁⨁⨁ High |
|||
| Caesarean delivery № of participants: 694 (9 RCTs) |
RR 0.52 (0.35, 0.76) |
20.2% |
10.5% (7.1, 15.3) |
9.7% fewer (13.1 fewer to 4.8 fewer) |
⨁⨁⨁⨁ High |
|||
| Duration of the first period of labor (min) № of participants: 746 (7 RCTs) |
– | – | MD 99.01 lower (153.35 lower to 44.66 lower) |
⨁⨁⨁◯ Moderatea |
||||
| Duration of the second period of labor (min) № of participants: 562 (6 RCTs) |
– | – | MD 11.29 lower (18.94 lower to 3.64 lower) |
⨁⨁⨁◯ Moderateb |
||||
| Perineal laceration (third or fourth-degree) № of participants: 300 (4 RCTs) |
RR 0.49 (0.25, 0.96) |
20.0% |
9.8% (5.0, 19.2) |
10.2% fewer (15 fewer to 0.8 fewer) |
⨁⨁⨁◯ Moderatec |
|||
| Pain intensity (VAS) № of participants: 658 (7 RCTs) |
– | – | MD 1.46 lower (2.52 lower to 0.41 lower) |
⨁⨁◯◯ Lowc,d |
||||
| Apgar Score (less than five at seven minute) № of participants: 240 (2 RCTs) |
RR 0.68 (0.20, 2.37) |
5.0% |
3.4% (1.0, 11.9) |
1.6% fewer (4 fewer to 6.9 more) |
⨁⨁◯◯ Lowc,f |
|||
*The risk in the intervention group (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI, confidence interval; MD, mean difference; RR, risk ratio.
GRADE Working Group grades of evidence.
High certainty: we are very confident that the true effect lies close to that of the estimate of the effect.
Moderate certainty: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different.
Low certainty: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect.
Very low certainty: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect.
Explanations.
a. There was high inconsistency (I2= 88%; p = 0.00001).
b. There was high inconsistency (I2= 53%; p = 0.06).
c. Wide confidence intervals.
d. There was high inconsistency (I2= 100%; p = 0.00001).
e. Insufficient number of subjects to evaluate the outcome studied.
f. Small number of studies.