Author Reply to “A randomized clinical trial for neck pain among adults”

We thank Drs Bashir and Soteriades for their interest in our article, their critical reading, their insightful comments, and the opportunity to respond to them.

They have correctly pointed out that a more rigorous randomization method should be employed in future studies. I agree that allocation concealment could have been achieved by third‐party concealment and that covariable adaptive randomization might have been more appropriate. I again agree that the results may also be attributed to Hawthorne effect and socially desirable responding. They rightly listed the possible cofounders and effect modifiers, the baseline imbalance of which we tried to minimize by randomization with allocation concealment. It is, however, deemed to be at high risk of bias by current assessment tool. ¹ , ² The interpretation of a randomized controlled trial must consider such methodological limitations along with other issues, such as the cost and ease of the intervention, and the potential value that individual patients and a population might enjoy from the intervention. ³ The simplicity, affordability, and noninvasiveness of Tasuki should also be considered when interpreting the trial. ⁴

I believe researchers need to clarify all major methodological issues in order for readers to appropriately understand the added value and the limitation of the article. I appreciate this letter to the editor for helping us further understand possible, more rigorous alternatives. Future studies with more rigorous methods will be desired.