Kurebayashi 2012.

Methods	RCT, Brazil
Participants	75 nurses at the Teaching Hospital of the University of São Paulo. "In order to define the sample of participants, the authors used the Stress Inventory or Stress Symptoms List – SSL. This instrument was applied to all subjects who agreed to participate in the study (N=109); however, only subjects who achieved mean (29 to 60 points), high (61 to 120 points) or very high (>120 points) scores were included in the sample; 75 of them completed the study. As for the distribution of the participants, 22 subjects were placed in the Control Group, 27 in the Needles Group and 26 in the Seeds Group." (p. 88) "The inclusion criteria were: belonging to the nursing team; voluntary participation in the study with avaiability to attend the sessions; obtaining a minimum SSL score at mean, high and very high stress level; not being pregnant. The authors excluded from the sample all the subjects who went on vacation or medical leave after the beginning of the study; did not show up to the session or gave up due to adverse effects, and those who had low SSL score." (p. 88)
Interventions	1) Experimental 1: Auriculotherapy (form of acupuncture performed on the ears) with needles (n = 27) 2) Experimental 2: Auriculotherapy with seeds (n = 26) 3) Control: No intervention(n = 22) "The intervention groups received eight sessions (one session a week), with duration of 5 to 10 minutes each session, on the Shenmen, Kidney and Brainstem points. The first two points have calmative properties and the kidney point has energetic function. After the location of the reactive points with a point locator, the ear auricle was hygienized with cotton and ethyl alcohol 70% and, then, semi‐permanent needles were applied or seeds were fixed with adhesive plaster, according to the intervention group. In the group of auriculo therapy with seeds, mustard seeds were used and the participants were instructed to stimulate them three times a day, for 15 times, with moderate pressure. The volunteers were instructed to remove the needles or seeds 24 hours before the session and, in case there was any discomfort, itching or signs of allergy, they should remove them before that." (p. 88)
Outcomes	Stress Symptoms List
Notes
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	"This randomized controlled clinical experiment was performed with three groups..." (p. 88)
Allocation concealment (selection bias)	Unclear risk	Not reported
Blinding (performance bias and detection bias) All outcomes	High risk	Blinding was not possible
Incomplete outcome data (attrition bias) All outcomes	High risk	"...there was a loss of 34 subjects during the study. Seven professionals went on vacation after the beginning of the study and two on medical leave; 12 missed the session because they had forgotten it, due to traffic problems or the difficulty to reschedule it and seven did not show up for the first session. One participant gave up due to adverse effects, in this case, nightmares, and five exclusions were due to low score (1), not belonging to the nursing team (3), and not filling out properly the questionnaires (1)." (p. 89) The authors do not report how the dropouts were distributed among the study groups.
Selective reporting (reporting bias)	High risk	The authors present data separately for participants who had had high SSL scores to begin with in table 2 but not at all for participants with a moderate SSL score.
Other bias	Unclear risk	We did not find any indications of other sources of bias.