Summary of findings for the main comparison. Antivirals plus corticosteroids compared to corticosteroids plus placebo or no treatment (AS versus OS) for Bell's palsy (idiopathic facial paralysis).
| Antivirals plus corticosteroids compared to corticosteroids plus placebo or no treatment (AS versus OS) for Bell's palsy (idiopathic facial paralysis) | ||||||
| Patient or population: Bell's palsy (idiopathic facial paralysis) Setting: primary, secondary and tertiary care Intervention: antivirals plus corticosteroids (AS) Comparison: corticosteroids plus placebo or no treatment (OS) | ||||||
| Outcomes | Relative effect (95% CI) | Anticipated absolute effects* (95% CI) | Certainty of the evidence (GRADE) | What happens | ||
| Corticosteroids plus placebo or no treatment (OS) | Antivirals plus corticosteroids (AS) | Difference with AS | ||||
| Incomplete recovery at end of study
№ of participants: 766
(3 RCTs) Follow‐up: 3 to 12 months |
RR 0.81 (0.38 to 1.74) | Study population | ⊕⊕⊝⊝ Lowa,b | There may be little or no difference between AS and OS in the proportion of participants with incomplete recovery at the end of the studies. | ||
| 172 per 1000 | 140 per 1000 (65 to 300) | 33 fewer per 1000 (107 fewer to 128 more) | ||||
| Motor synkinesis or crocodile tears
№ of participants: 469
(2 RCTs) Follow‐up: 3 to 12 months |
RR 0.56 (0.36 to 0.87) | Study population | ⊕⊕⊕⊝ Moderatec | AS probably reduces the proportion of participants with motor synkinesis or crocodile tears at 3 to 12 months compared to OS. | ||
| 194 per 1000 | 109 per 1000 (70 to 169) | 85 fewer per 1000 (124 fewer to 25 fewer per 1000) | ||||
| Adverse events
№ of participants: 656
(2 RCTs) Follow‐up: 3 to 12 months |
RR 1.17 (0.81 to 1.68) | Study population | ⊕⊝⊝⊝ Very lowd,e | It is uncertain whether the number of people who experience adverse events is different with AS than OS. | ||
| 136 per 1000 | 160 per 1000 (110 to 229) | 24 more per 1000 (26 fewer to 93 more) | ||||
| *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). AS: antivirals plus corticosteroids; CI: confidence interval; OS: corticosteroids plus placebo or no treatment; 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. | ||||||
aWe downgraded the certainty of evidence once due to differing results of the included studies (inconsistency). As our primary analysis we reported the results of a sensitivity analysis excluding 10 of 13 trials which were at high or unclear risk of bias in several domains. The effect estimate from the full data set was RR 0.54, 95% CI 0.38 to 0.77; 13 trials, N = 1729 , but there were very serious study limitations in the full data set, in addition to heterogeneity. bWe downgraded the certainty of the body of evidence once because the RR had wide CIs that included the possibility of a very little effect and a large effect (imprecision). cWe downgraded the certainty of evidence for this outcome for publication bias, as only two studies in this comparison reported this outcome. dWe downgraded the certainty of the body of evidence for this outcome once for publication bias as only 4 of the 13 studies reported adverse events. eWe downgraded the certainty of the body of evidence twice for imprecision as the CIs were wide and encompassed the possibility of an effect in either direction.