| Methods |
Random allocation: Yes; Concealed allocation: No; Baseline comparability: Yes; Blind assessors: Yes; Blind subjects: No; Blind therapists: No; Adequate follow‐up: Yes; Intention‐to‐treat analysis: No; Between‐group comparisons: Yes; Point estimates and variability: Yes; Eligibility criteria: Yes |
| Participants |
60 outpatients (mean age acupuncture group 52.3; mean age steroid plus placebo 54.1; mean age steroid plus tolmentin 51.2; mean age physiotherapy 55.1; mean age placebo 56.2) (with an uncomplicated rotator‐cuff lesion defined as pain on resisted movements of the shoulder with or without some loss of passive movement, mainly abduction |
| Interventions |
Four weeks of:
Group 1: Acupuncture for 20 minutes weekly, using classical Chinese acupuncture with moxibustion
Group 2: Steroid injection of 40 mg methylprednisolone with 2 ml 2% lignocaine using anterior appraoch to the shoulder joint plus placebo tolmentin (2 tablets 3 times daily)
Group 3: Steroid injection plus active tolmetin sodium (a non steroidal anti‐inflamtory drug) (400 mg 3 times daily)
Group 4: Physiotherapy of standardised ultrasound for 10 minutes for eight sessions
Group 5: Placebo tolmetin plus placebo ultrasound |
| Outcomes |
Assessed at start of study and at 2 and 4 weeks on:
1. Pain measured by visual analogue scale and 4 point scale (none, mild, moderate, servere pain); 2. Active total shoulder abduction using a goniometer; 3. Comparative assessment by patient and assessor (much better, better, same, worse, much worse); 5. Success or failure of the treatment at the end of four weeks, defined as need for steroid injection; 6. Adverse outcomes |
| Notes |
|
| Risk of bias |
| Bias |
Authors' judgement |
Support for judgement |
| Allocation concealment (selection bias) |
High risk |
C ‐ Inadequate |
