Table 4.
GRADE summary of findings.
| Outcome | Certainty Assessment | No. of Patients | Effect | Certainty | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| No. of Studies | Study Design | Risk of Bias | Inconsistency | Indirectness | Imprecision | Other Considerations | Balneotherapy | Control | Relative(95% CI) | Absolute (95% CI) |
||
| Pain at 2 weeks | 5 | Randomized trials | Serious | Very serious | Not serious | Not serious | None | 138 | 137 | - | SMD 0.92 lower (1.13 lower to 0.53 lower) |
⨁◯◯◯ VERY LOW |
| Pain at 3 months | 6 | Randomized trials | Serious | Not serious | Not serious | Not serious | None | 211 | 228 | - | SMD 0.45 lower (0.73 lower to 0.16 lower) |
⨁⨁⨁◯ MODERATE |
| Pain at 6 months | 5 | Randomized trials | Serious | Serious | Not serious | Not serious | None | 177 | 189 | - | SMD 0.7 lower (1.34 lower to 0.05 lower) |
⨁⨁◯◯ LOW |
| FIQ at 2 weeks | 7 | Randomized trials | Serious | Serious | Not serious | Not serious | None | 190 | 186 | - | SMD 1.01 lower (1.43 lower to 0.59 lower) |
⨁⨁◯◯ LOW |
| FIQ at 3 months | 7 | Randomized trials | Serious | Serious | Not serious | Not serious | None | 236 | 253 | - | SMD 0.64 lower (0.95 lower to 0.33 lower) |
⨁⨁◯◯ LOW |
| FIQ at 6 months | 4 | Randomized trials | Serious | Very serious | Not serious | Not serious | None | 155 | 169 | - | SMD 0.59 lower (0.91 lower to 0.27 lower) |
⨁◯◯◯ VERY LOW |
| TPC at 2 weeks | 3 | Randomized trials | Serious | Very serious | Not serious | Not serious | None | 57 | 57 | - | SMD 0.9 lower (2.02 lower to 0.23 higher) |
⨁◯◯◯ VERY LOW |
| TPC at 3 months | 4 | Randomized trials | Serious | Not serious | Not serious | Not serious | None | 126 | 143 | - | SMD 0.47 lower (0.71 lower to 0.22 lower) |
⨁⨁⨁◯ MODERATE |
| TPC at 6 months | 4 | Randomized trials | Serious | Very serious | Not serious | Not serious | None | 127 | 139 | - | SMD 0.89 lower (1.85 lower to 0.07 higher) |
⨁◯◯◯ VERY LOW |
| BDI at 2 weeks | 4 | Randomized trials | Serious | Not serious | Not serious | Not serious | None | 84 | 81 | - | SMD 0.32 lower (0.63 lower to 0.01 lower) |
⨁⨁⨁◯ MODERATE |
| BDI at 3 months | 4 | Randomized trials | Serious | Serious | Not serious | Not serious | None | 133 | 148 | - | SMD 0.23 lower (0.64 lower to 0.17 higher) |
⨁⨁◯◯ LOW |
| BDI at 6 months | 3 | Randomized trials | Serious | Not serious | Not serious | Not serious | None | 96 | 109 | - | SMD 0.45 lower (0.73 lower to 0.17 lower) |
⨁⨁⨁◯ MODERATE |
CI: confidence interval; SMD: standardized mean difference; TPC, Tender Points Count; BDI, Beck’s Depression Index. ⨁⨁⨁⨁: High quality—We are very confident that the true effect lies close to that of the estimate of the effect; ⨁⨁⨁◯: Moderate quality—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 quality ()—Our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect; ⨁◯◯◯: Very low quality—We have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect