HILT Compared to Placebo/Active Comparator for the Treatment of Chronic Musculoskeletal Pain
Certainty Assessment							Summary of Findings
Participants(Studies) Follow-up	Risk of Bias	Inconsistency	Indirectness	Imprecision	Publication Bias	Overall Certainty of Evidence	Impact
Pain (assessed with: VAS, NRS)
726 (13 RCTs)	not serious a	not serious	not serious	Serious b	none c	⨁⨁⨁◯ Moderate	HILT may relieve pain in chronic musculoskeletal pain conditions.
Function (assessed with: ODI, MODQ, RMQ, PDI, NDI, JFLS-20)
726 (13 RCTs)	not serious a	not serious	not serious	Serious b	none c	⨁⨁⨁◯ Moderate	HILT may improve function in chronic musculoskeletal pain conditions.
JFLS-20: Jaw Functional Limitation Scale 20; MODQ: Modified Oswestry Disability Questionnaire; NDI: Neck disability index; ODI; Oswestry Disability Index; PDI: Pain disability Index; RDQ: Roland disability questionnaire; VAS: visual analogue scale; NRS: Numeric rating scale, PDI: Pain Disability Index   Explanations a. Most of the studies (7 out of 13) had a low risk of bias or some concern. Five studies had an increase in their overall risk of bias because they omitted to report the concealment method (unclear concealment). Five studies had an increase in their overall risk of bias because blinding was impossible (comparing HILT to another treatment modality) and patient-reported outcomes were used (inevitable to assess pain and function). A downgrade in the risk score is automatically attributed in RoB 2.0 when patients become assessors of their own condition via self-reported outcomes and when they cannot be blinded to their allocated interventions. Since these potential limitations are unlikely to lower confidence in the overall results, the evidence was not downgraded for the risk of bias. b. A narrative synthesis was conducted. Estimates may not be precise as the calculated effect sizes were not available for all included studies. c. A statistical evaluation of publication bias was not possible in this case. Although the review presents mostly positive studies, publication bias is unlikely due to the comprehensive search that has been completed.