Summary of findings 4. Boswellia serrata (enriched) plus non‐volatile oil for treating osteoarthritis.

Boswellia serrata (enriched) plus non‐volatile oil for treating osteoarthritis
Patient or population: patients with treating osteoarthritis Settings: Community: India Intervention:Boswellia serrata (enriched) 100mg plus non‐volatile oil
Outcomes	Illustrative comparative risks* (95% CI)		Relative effect (95% CI)	No of Participants (studies)	Quality of the evidence (GRADE)	Comments
	Assumed risk	Corresponding risk
	Control	Boswellia serrata (enriched) plus non‐volatile oil
Pain Global pain VAS 0‐100 (higher scores mean worse) Follow‐up: 30‐90 days1	Weighted mean pain in the control groups at the end of treatment was 38.90 (0 to 100 scale).	Weighted mean pain in the intervention groups was 16.09 lower (20.37 to 11.81 lower).	‐	97 (2 studies)	⊕⊕⊕⊝ moderate2	Absolute improvement in pain was 16% (12% to 20%); Relative improvement in pain was 34%(25% to 42%)3; NNTB 2 (1 to 4)4
Function WOMAC‐VAS (Function)5 normalised units (higher scores mean worse) Follow‐up: 30‐90 days	Weighted mean disability in the control groups at the end of treatment was 34.90 (0 to 100 scale).	Weighted mean disability in the intervention groups was 15.01 lower (19.21 to 10.81 lower).	‐	97 (2 studies)	⊕⊕⊕⊝ moderate2	Absolute improvement in disability was 15% (11% to 19%); Relative improvement in disability was 37% (27% to 47%)3; NNTB 2 (1 to 3).
Adverse events Participants (n) reported adverse events Follow‐up: 30‐90 days	42 per 1000	41 per 1000 (6 to 241)	RR 0.98 (0.14 to 6.69)	97 (2 studies)	⊕⊕⊕⊝ moderate2	Absolute risk of adverse events was 0% lower in the Boswellia serrata group (8% lower to 8% higher); Relative percentage change 2% improvement (86% improvement to 569% worsening); NNT n/a.5
Adverse events Participants (n) withdrew due to adverse effects	See comment	See comment	Not estimable	‐	See comment	Reported NIL withdrawals due to adverse events.
Adverse events Participants (n) reported serious adverse events	See comment	See comment	Not estimable	‐	See comment	Reported NIL serious adverse events.
Radiographic joint changes	See comment	See comment	Not estimable	‐	See comment	Radiographic joint changes not measured.
Quality of life	See comment	See comment	Not estimable	‐	See comment	Quality of life not measured.
*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; OR: Odds ratio
GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate.

¹Vishal 2011: 30 day intervention. Sengupta 2010: 90 day intervention.
 ²Vishal 2011: Exploratory study design; power, effect, and sample size not determined a priori.
 ³ Control group baseline measures taken from Vishal 2011, the study most heavily weighted in the meta‐analyses. Control group baseline pain 47.6 (9.7), baseline disability 40.6 (9.5).

⁴ Number needed to treat to benefit (NNTB), and harm (NNTH) = not applicable (n/a) when result is not statistically significant. NNT for continuous outcomes calculated using Wells Calculator (CMSG editorial office). NNT for dichotomous outcomes calculated using Cates NNT calculator (http://www.nntonline.net/visualrx/).

⁵Sengupta 2010, Vishal 2011: WOMAC scores presented as subscale scores only. Overall WOMAC not reported.