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

Table 3 Summary of quality of evidence using the GRADE approach

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

CI Confidence interval, SMD Standardised mean difference
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
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
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
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
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

ISSN: 1471-2474