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. 2020 Jul 5;2020(7):CD009169. doi: 10.1002/14651858.CD009169.pub3

2. Criteria for a judgement of 'yes' for the sources of risk of bias*.

1 A random (unpredictable) assignment sequence. Examples of adequate methods are coin toss (for studies with 2 groups), rolling a dice (for studies with 2 or more groups), drawing of balls of different colours, drawing of ballots with the study group labels from a dark bag, computer‐generated random sequence, preordered sealed envelopes, sequentially ordered vials, telephone call to a central office, and preordered list of treatment assignments. Examples of inadequate methods are: alternation, birth date, social insurance/security number, date in which they were invited to participate in the study, and hospital registration number.
2 Assignment generated by an independent person not responsible for determining the eligibility of the patients. This person has no information about the individuals included in the trial and has no influence on the assignment sequence or on the decision about eligibility of the patient.
3 Index and control groups are indistinguishable for the participants or if the success of blinding was tested amongst the participants and it was successful.
4 Index and control groups are indistinguishable for the care providers or if the success of blinding was tested amongst the care providers and it was successful.
5 Adequacy of blinding should be assessed for each primary outcome separately. This item should be scored 'yes' if the success of blinding was tested amongst the outcome assessors and it was successful, or:
  • for patient‐reported outcomes in which the participant is the outcome assessor (e.g. pain, disability): the blinding procedure is adequate for outcome assessors if participant blinding is scored 'yes';

  • for outcome criteria assessed during scheduled visit and that supposes a contact between participants and outcome assessors (e.g. clinical examination): the blinding procedure is adequate if participants are blinded, and the treatment or adverse effects of the treatment cannot be noticed during clinical examination;

  • for outcome criteria that do not suppose a contact with participants (e.g. radiography, magnetic resonance imaging): the blinding procedure is adequate if the treatment or adverse effects of the treatment cannot be noticed when assessing the main outcome;

  • for outcome criteria that are clinical or therapeutic events that will be determined by the interaction between participants and care providers (e.g. co‐interventions, hospitalisation length, treatment failure), in which the care provider is the outcome assessor: the blinding procedure is adequate for outcome assessors if item 4 (caregivers) is scored 'yes';

  • for outcome criteria that are assessed from data of the medical forms: the blinding procedure is adequate if the treatment or adverse effects of the treatment cannot be noticed on the extracted data.

6 The number of participants who were included in the study but did not complete the observation period or were not included in the analysis must be described and reasons given. If the percentage of withdrawals and dropouts does not exceed 20% for short‐term follow‐up and 30% for long‐term follow‐up and does not lead to substantial bias, a 'yes' is scored (NB these percentages are arbitrary, not supported by literature).
7 All randomised participants are reported/analysed in the group to which they were allocated by randomisation for the most important moments of effect measurement (minus missing values) irrespective of non‐compliance and co‐interventions.
8 All results from all prespecified outcomes have been adequately reported in the published report of the trial. This information is either obtained by comparing the protocol and the report, or in the absence of the protocol, assessing that the published report includes enough information to make this judgement.
9 Groups must be similar at baseline regarding demographic factors, duration and severity of complaints, percentage of participants with neurological symptoms, and value of main outcome measure(s).
10 If there were no co‐interventions, or they were similar between the index and control groups.
11 The review author determines if the compliance with the interventions is acceptable, based on the reported intensity, duration, number, and frequency of sessions for both the index intervention and the control intervention(s). For example, physiotherapy treatment is usually administered for several sessions, therefore it is necessary to assess how many sessions each participant attended. For single‐session interventions (e.g. surgery), this item is irrelevant.
12 Timing of outcome assessment should be identical for all intervention groups and for all primary outcome measures.
13 Other types of biases. For example:
  • when the outcome measures were not valid. There should be evidence from a previous or present scientific study that the primary outcome can be considered valid in the context of the present;

  • industry‐sponsored trials. The conflict of interest (COI) statement should explicitly state that the researchers have had full possession of the trial process from planning to reporting without funders with potential COI having any opportunity to interfere in the process. If, for example, the statistical analyses have been done by a funder with a potential COI, usually 'unsure' is scored.