Nabeta 2002

Methods	RCT Number analysed/randomised: 34/34 Intention‐to‐treat: calculated Power analysis: NR Funding source: NR
Participants	Chronic neck pain, no radicular signs Participant recruitment: students from an acupuncture school in Japan
Interventions	Treatment was provided to 'tender points' on the posterior aspect of the neck and upper back "All tender points were carefully detected where the subjects felt dull pain and stiffness (neck, shoulder, and back) and were used for the acupuncture treatment. All tender points were treated in each group” INDEX TREATMENT 'Sparrow pecking' acupuncture Disposable stainless needles (0.2 mm × 40 mm) were inserted into the muscle to a depth of about 20 mm, and the ‘sparrow pecking’ technique was applied. When the participant felt Deqi, the manipulation was stopped and the needle was retained for 5 more minutes COMPARISON TREATMENT Simulated 'sparrow pecking' acupuncture with no needle insertion For sham acupuncture, similar stainless needles (0.2 mm × 40 mm) were used, but the tips had previously been cut off to prevent the needle from penetrating the skin. The cut ends were smoothed with sandpaper manually under clean conditions. The acupuncturist pretended to insert the needle and to use the sparrow pecking technique, then removed the needles. Simulation of needle extraction was performed after 5 minutes CO‐INTERVENTION Not specified Duration of treatment: once/wk for 3 weeks Duration of follow‐up: 9 days
Outcomes	PAIN INTENSITY: VAS Baseline mean: acupuncture 60.5, sham 48.8 End of study mean: acupuncture 43.3, sham 46.8 Absolute benefit: acupuncture 17.2, sham 2.0 Reported results: significant favouring acupuncture SMD ‐0.15 (95% CI random ‐0.82 to 0.52) at 9 days Reasons for drop‐out: NR Adverse effects: none Costs of care: NR
Notes	‐‐
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Computerised randomisation programme
Allocation concealment (selection bias)	Unclear risk	Not reported
Blinding (performance bias and detection bias) All outcomes ‐ patient?	Low risk	Reported as blinded
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 was blinded
Incomplete outcome data (attrition bias) All outcomes ‐ Drop out rate acceptable?	Low risk	No drop‐outs
Incomplete outcome data (attrition bias) All outcomes ‐ Analyzed in the group to which they were allocated?	Low risk	No drop‐outs
Selective reporting (reporting bias)	Unclear risk	No protocol
Similarity of baseline characteristics	Low risk	Reported to be similar but baseline VAS different by 11.7
Co‐interventions avoided or similar?	Unclear risk	Not reported
Compliance acceptable?	High risk	Some participants did not receive all treatment
Similar timing of outcome assessment?	Low risk	9 days
Fatal Flaw	Low risk	Acceptable