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Table 3 Summary of quality of evidence using the GRADE approach

From: The effectiveness of interventions aimed at increasing physical activity in adults with persistent musculoskeletal pain: a systematic review and meta-analysis

Quality assessment № of patients Effect Quality
№ of studies Study design Risk of bias (a) Inconsistency (b) Indirectness (c) Imprecision (d) Other considerations (e) Interventions control Absolute(95% CI)  
Short-term Subjective Physical Activity
 9 randomised trials serious serious not serious serious none 611 485 SMD 0.24 SD higher (−0.07 lower to 0.55 higher) VERY LOW
Medium-Term Subjective Physical Activity (follow up: range 12 weeks to 6 months)
 9 randomised trials serious serious not serious not serious none 757 552 SMD 0.25 SD higher (0.01 higher to 0.48 higher) LOW
Long-Term Subjective Physical Activity (follow up: >6 months)
 11 randomised trials serious not serious not serious not serious none 1068 804 SMD 0.21 SD higher(0.08 higher to 0.33 higher) MODERATE
Short-Term Objective Physical Activity
 7 randomised trials serious serious not serious serious none 255 186 SMD 0.31 SD higher(−0.11 lower to 0.74 higher) VERY LOW
Medium-Term Objective Physical Activity (follow up: range 12 weeks to 6 months)
 4 randomised trials not serious not serious not serious very serious none 135 110 SMD −0.02 SD lower(−0.40 lower to 0.36 higher) LOW
Long-Term Objective Physical Activity (follow up: range 6+ months)
 4 randomised trials serious not serious not serious serious none 251 184 SMD 0.22 SD higher(−0.02 lower to 0.46 higher) LOW
  1. CI Confidence interval, SMD Standardised mean difference
  2. a. Risk of Bias – Using weighting shown in RevMan analysis a serious downgrade is applied where 25% or more of the results are derived from studies judged to be at high risk of bias (see methods for details), a very serious downgrade is applied where 50% of weighting is derived from studies at high risk of bias
  3. b. Inconsistency – a serious downgrade was applied if there is substantial statistical heterogeneity indicated by an (I2) of 50 to 90%. A very serious downgrade is applied if there was substantial heterogeneity and there was inconsistency arising from the populations, interventions or outcomes
  4. c. Indirectness – a serious downgrade is applied if there was indirectness in one of population, intervention, comparator or outcome. A very serious downgrade was applied if there was indirectness in more than one area
  5. d. Imprecision –a serious downgrade is applied when the total population size is less than 400 (provided there is more than one study). Or, if the 95% CI includes 0 (no effect) or the upper and lower confidence interval cross an effect size (SMD) of 0.5 in either direction. A very serious downgrade is applied where there is a small population and imprecision of the effect estimate
  6. e. Where there was sufficient papers (10) a funnel plot was prepared and inspected, a serious downgrade was applied if this suggested a publication bias