Bernhardt 1991.

Methods	Randomised, double‐blind, placebo control, active control (unblinded), 3 parallel groups. Duration 4 weeks
Participants	Randomised n=108; intervention n=36, placebo n=36, piroxicam n=36. Completed n=108. Mean age 52 yrs. M:F 22:50. Inclusion: OA (criteria not specified), acute or recurrent degenerative arthritic complaints
Interventions	PhytodolorRN: standardised extract mixture of ash bark, aspen leaf, aspen bark, golden rod herb, 3 x 30 drops, tincture Active control: piroxicam (Feldene 20), 20mg, OD Placebo control: ingredients not reported Concurrent treatment permitted: balneology (thermal baths), and physiotherapy
Outcomes	Pain with movement 0‐3, enduring pain 0‐3, mobility impairment 0‐3, finger‐ground distance, grip strength, PGA 0‐6, patient perception efficacy 0‐3
Notes	Exploratory study design; power, effect, and sample size not determined a priori. Did not report ethical oversight or compliance with guidelines. Results favour intervention. Some outcome measures (eg: finger‐ground distance) are non‐specific and may be of limited use in rheumatological assessment.
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Randomised to one of three groups using a table of random numbers
Allocation concealment (selection bias)	Unclear risk	Allocation concealment not reported
Blinding (performance bias and detection bias) All outcomes	Unclear risk	Described as double‐blind. In PhytodolorRN and placebo groups, active intervention and placebo not distinguished by look, taste, smell or packaging (low risk) Piroxicam group not blinded (unclear risk)
Incomplete outcome data (attrition bias) All outcomes	Low risk	Reported no withdrawals (low risk) Intention‐to‐treat analysis can be assumed
Selective reporting (reporting bias)	Unclear risk	Most outcome data reported as change scores, percentages, graphs and p values only, insufficient for extraction (unclear risk) Reported adverse events (low risk)
Other bias	High risk	Diagnosis not based on ACR criteria. Non‐homogenous sample (any degenerative arthropathy, any site) (high risk) Unvalidated outcome measures (unclear risk)