Fu 2009

Methods	RCT Number Analysed/randomised: 112/117 Intention‐to‐treat: NR Power analysis: NR Funding source: State Ministry of Science and Technology
Participants	Chronic cervical spondylosis Participant recruitment: Acupuncture Department of Guangdong Provincial Traditional Chinese Medicine Hospital, China
Interventions	INDEX TREATMENT Acupuncture group Acupuncture points ‐ Du14, ExHN15, SI15 needles inserted to muscle layer manipulated for Deqi, then remained inserted for 20 minutes; infrared radiation COMPARISON TREATMENT Sham Superficial insertion 1 cm apart laterally from acupuncture points. Remained for 20 minutes, no manipulation; infrared radiation CO‐INTERVENTION NR Treatment schedule: once every other day for 9 sessions over 18 days Duration of follow‐up: immediate post treatment, 4 weeks, 3 months
Outcomes	PAIN INTENSITY (0 to 10 VAS scale) Baseline mean: acupuncture 5.14, sham 5.58 End of study mean: acupuncture 2.89, sham 3.28 at 3 month follow‐up Absolute benefit: acupuncture 2.25, sham 2.30 Reported results: significant immediate post treatment favouring acupuncture but not over long term SMD ‐0.53 (95% CI random ‐0.91 to ‐0.16) immediate post treatment SMD ‐0.59 (95% CI random ‐0.97 to ‐0.21) at 4 weeks SMD ‐0.23 (95% CI random ‐0.61 to 0.14) at 3 months Northwick Park Pain Questionnaire (NPQ) (0 to 100) Baseline mean: acupuncture 33.63, sham 33.21 End of study mean: acupuncture 20.55, sham 25.77 Absolute benefit: acupuncture 13.08, sham 7.44 Reported results: significant immediate post treatment favouring acupuncture but not over long term SMD ‐0.41 (95% CI random ‐0.79 to ‐0.04) immediate post treatment SMD ‐0.50 (95% CI random ‐0.88 to ‐0.12) at 4 weeks SMD ‐0.40 (95% CI random ‐0.78 to ‐0.03) at 3 months Reasons for drop‐out: 2 fainted, 3 inconvenient (rate 4.27%) Adverse effects: 1 in each group fainted Costs of care: NR
Notes	‐‐
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Computerised sequence number and grouping address on a randomising card
Allocation concealment (selection bias)	Low risk	Use of sealed opaque envelopes
Blinding (performance bias and detection bias) All outcomes ‐ patient?	Low risk	Described adequately in the report
Blinding (performance bias and detection bias) All outcomes ‐ care provider?	High risk	Not possible
Blinding (performance bias and detection bias) All outcomes ‐ outcome assessor?	Low risk	Participant as outcome assessor
Incomplete outcome data (attrition bias) All outcomes ‐ Drop out rate acceptable?	Low risk	Described and acceptable 4.27%
Incomplete outcome data (attrition bias) All outcomes ‐ Analyzed in the group to which they were allocated?	High risk	Not all randomised participants were analysed
Selective reporting (reporting bias)	Unclear risk	No protocol
Similarity of baseline characteristics	Low risk	Reported to be similar
Co‐interventions avoided or similar?	Unclear risk	Not reported
Compliance acceptable?	Unclear risk	Not reported
Similar timing of outcome assessment?	Low risk	Post, 4 weeks, 12 weeks
Fatal Flaw	High risk	No sample size justifications; multiple comparisons should have been done; analysis should have been stratified by syndrome type; time lines between points on graph are distorted