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Percusión, diuresis y tratamiento de inversión para el paso de los cálculos renales del polo inferior después de la litotripsia por ondas de choque

Appendices

Appendix 1. Electronic search strategies

Database

Search terms

CENTRAL

  1. MeSH descriptor Nephrolithiasis explode all trees

  2. (kidney stone*):ti,ab,kw or (kidney calcul*):ti,ab,kw in Clinical Trials

  3. (renal stone*):ti,ab,kw or (renal calcul*):ti,ab,kw in Clinical Trials

  4. (#1 OR #2 OR #3)

  5. MeSH descriptor Percussion, this term only

  6. (percussion*):ti,ab,kw in Clinical Trials

  7. (percussion*):ti,ab,kw in Clinical Trials

  8. MeSH descriptor Diuretics explode all trees

  9. MeSH descriptor Diuresis explode all trees

  10. (diuresis):ti,ab,kw or (diuretic*):ti,ab,kw in Clinical Trials

  11. MeSH descriptor Posture explode all trees

  12. (inversion*):ti,ab,kw in Clinical Trials

  13. (postur*):ti,ab,kw or (position*):ti,ab,kw in Clinical Trials

  14. MeSH descriptor Lithotripsy explode all trees

  15. (lithotrips*):ti,ab,kw in Clinical Trials

  16. (#5 OR #6 OR #7 OR #8 OR #9 OR #10 OR #11 OR #12 OR #13 OR #14 OR #15)

  17. (#4 AND #16)

MEDLINE (OVID)

  1. exp Nephrolithiasis/

  2. (kidney stone$ or kidney calcul$).tw.

  3. (renal stone$ or renal calcul$).tw.

  4. or/1‐3

  5. Percussion/

  6. percussion$.tw.

  7. exp Diuretics/

  8. exp Diuresis/

  9. (diuresis or diuretic$).tw.

  10. exp Posture/

  11. inversion.tw.

  12. (postur$ or position).tw.

  13. exp Lithotripsy/

  14. or/5‐13

  15. and/4,14

EMBASE (OVID)

  1. Nephrolithiasis/

  2. (kidney stone$ or kidney calcul$).tw.

  3. (renal stone$ or renal calcul$).tw.

  4. or/1‐3

  5. percussion/

  6. percussion$.tw.

  7. exp diuresis/

  8. exp Diuretic Agent/

  9. (diuresis or diuretic$).tw.

  10. exp body position/

  11. inversion.tw.

  12. (postur$ or position).tw.

  13. exp lithotripsy/

  14. lithotripsy.tw.

  15. or/5‐14

  16. and/4,15

Appendix 2. Risk of bias assessment tool

Potential source of bias

Assessment criteria

Random sequence generation

Selection bias (biased allocation to interventions) due to inadequate generation of a randomised sequence

Low risk of bias: Random number table; computer random number generator; coin tossing; shuffling cards or envelopes; throwing dice; drawing of lots; minimization (minimization may be implemented without a random element, and this is considered to be equivalent to being random).

High risk of bias: Sequence generated by odd or even date of birth; date (or day) of admission; sequence generated by hospital or clinic record number; allocation by judgement of the clinician; by preference of the participant; based on the results of a laboratory test or a series of tests; by availability of the intervention.

Unclear: Insufficient information about the sequence generation process to permit judgement.

Allocation concealment

Selection bias (biased allocation to interventions) due to inadequate concealment of allocations prior to assignment

Low risk of bias: Randomisation method described that would not allow investigator/participant to know or influence intervention group before eligible participant entered in the study (e.g. central allocation, including telephone, web‐based, and pharmacy‐controlled, randomisation; sequentially numbered drug containers of identical appearance; sequentially numbered, opaque, sealed envelopes).

High risk of bias: Using an open random allocation schedule (e.g. a list of random numbers); assignment envelopes were used without appropriate safeguards (e.g. if envelopes were unsealed or non‐opaque or not sequentially numbered); alternation or rotation; date of birth; case record number; any other explicitly unconcealed procedure.

Unclear: Randomisation stated but no information on method used is available.

Blinding of participants and personnel

Performance bias due to knowledge of the allocated interventions by participants and personnel during the study

Low risk of bias: No blinding or incomplete blinding, but the review authors judge that the outcome is not likely to be influenced by lack of blinding; blinding of participants and key study personnel ensured, and unlikely that the blinding could have been broken.

High risk of bias: No blinding or incomplete blinding, and the outcome is likely to be influenced by lack of blinding; blinding of key study participants and personnel attempted, but likely that the blinding could have been broken, and the outcome is likely to be influenced by lack of blinding.

Unclear: Insufficient information to permit judgement

Blinding of outcome assessment

Detection bias due to knowledge of the allocated interventions by outcome assessors.

Low risk of bias: No blinding of outcome assessment, but the review authors judge that the outcome measurement is not likely to be influenced by lack of blinding; blinding of outcome assessment ensured, and unlikely that the blinding could have been broken.

High risk of bias: No blinding of outcome assessment, and the outcome measurement is likely to be influenced by lack of blinding; blinding of outcome assessment, but likely that the blinding could have been broken, and the outcome measurement is likely to be influenced by lack of blinding.

Unclear: Insufficient information to permit judgement

Incomplete outcome data

Attrition bias due to amount, nature or handling of incomplete outcome data.

Low risk of bias: No missing outcome data; reasons for missing outcome data unlikely to be related to true outcome (for survival data, censoring unlikely to be introducing bias); missing outcome data balanced in numbers across intervention groups, with similar reasons for missing data across groups; for dichotomous outcome data, the proportion of missing outcomes compared with observed event risk not enough to have a clinically relevant impact on the intervention effect estimate; for continuous outcome data, plausible effect size (difference in means or standardized difference in means) among missing outcomes not enough to have a clinically relevant impact on observed effect size; missing data have been imputed using appropriate methods.

High risk of bias: Reason for missing outcome data likely to be related to true outcome, with either imbalance in numbers or reasons for missing data across intervention groups; for dichotomous outcome data, the proportion of missing outcomes compared with observed event risk enough to induce clinically relevant bias in intervention effect estimate; for continuous outcome data, plausible effect size (difference in means or standardized difference in means) among missing outcomes enough to induce clinically relevant bias in observed effect size; ‘as‐treated’ analysis done with substantial departure of the intervention received from that assigned at randomisation; potentially inappropriate application of simple imputation.

Unclear: Insufficient information to permit judgement

Selective reporting

Reporting bias due to selective outcome reporting

Low risk of bias: The study protocol is available and all of the study’s pre‐specified (primary and secondary) outcomes that are of interest in the review have been reported in the pre‐specified way; the study protocol is not available but it is clear that the published reports include all expected outcomes, including those that were pre‐specified (convincing text of this nature may be uncommon).

High risk of bias: Not all of the study’s pre‐specified primary outcomes have been reported; one or more primary outcomes is reported using measurements, analysis methods or subsets of the data (e.g. subscales) that were not pre‐specified; one or more reported primary outcomes were not pre‐specified (unless clear justification for their reporting is provided, such as an unexpected adverse effect); one or more outcomes of interest in the review are reported incompletely so that they cannot be entered in a meta‐analysis; the study report fails to include results for a key outcome that would be expected to have been reported for such a study.

Unclear: Insufficient information to permit judgement

Other bias

Bias due to problems not covered elsewhere in the table

Low risk of bias: The study appears to be free of other sources of bias.

High risk of bias: Had a potential source of bias related to the specific study design used; stopped early due to some data‐dependent process (including a formal‐stopping rule); had extreme baseline imbalance; has been claimed to have been fraudulent; had some other problem.

Unclear: Insufficient information to assess whether an important risk of bias exists; insufficient rationale or evidence that an identified problem will introduce bias.

Study flow diagram
Figures and Tables -
Figure 1

Study flow diagram

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
Figures and Tables -
Figure 2

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
Figures and Tables -
Figure 3

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

Comparison 1 Percussion, diuresis, and inversion therapy following shock wave lithotripsy versus no intervention following shock wave lithotripsy, Outcome 1 Stone‐free rate.
Figures and Tables -
Analysis 1.1

Comparison 1 Percussion, diuresis, and inversion therapy following shock wave lithotripsy versus no intervention following shock wave lithotripsy, Outcome 1 Stone‐free rate.

Comparison 1 Percussion, diuresis, and inversion therapy following shock wave lithotripsy versus no intervention following shock wave lithotripsy, Outcome 2 Stone burden reduction.
Figures and Tables -
Analysis 1.2

Comparison 1 Percussion, diuresis, and inversion therapy following shock wave lithotripsy versus no intervention following shock wave lithotripsy, Outcome 2 Stone burden reduction.

Comparison 1 Percussion, diuresis, and inversion therapy following shock wave lithotripsy versus no intervention following shock wave lithotripsy, Outcome 3 Complications.
Figures and Tables -
Analysis 1.3

Comparison 1 Percussion, diuresis, and inversion therapy following shock wave lithotripsy versus no intervention following shock wave lithotripsy, Outcome 3 Complications.

Comparison 2 Percussion, diuresis, and inversion plus shock wave lithotripsy therapy versus shock wave lithotripsy alone, Outcome 1 Stone‐free rate.
Figures and Tables -
Analysis 2.1

Comparison 2 Percussion, diuresis, and inversion plus shock wave lithotripsy therapy versus shock wave lithotripsy alone, Outcome 1 Stone‐free rate.

Comparison 2 Percussion, diuresis, and inversion plus shock wave lithotripsy therapy versus shock wave lithotripsy alone, Outcome 2 Stone burden reduction.
Figures and Tables -
Analysis 2.2

Comparison 2 Percussion, diuresis, and inversion plus shock wave lithotripsy therapy versus shock wave lithotripsy alone, Outcome 2 Stone burden reduction.

Comparison 2 Percussion, diuresis, and inversion plus shock wave lithotripsy therapy versus shock wave lithotripsy alone, Outcome 3 Complications.
Figures and Tables -
Analysis 2.3

Comparison 2 Percussion, diuresis, and inversion plus shock wave lithotripsy therapy versus shock wave lithotripsy alone, Outcome 3 Complications.

Comparison 1. Percussion, diuresis, and inversion therapy following shock wave lithotripsy versus no intervention following shock wave lithotripsy

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Stone‐free rate Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

2 Stone burden reduction Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Totals not selected

3 Complications Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

Figures and Tables -
Comparison 1. Percussion, diuresis, and inversion therapy following shock wave lithotripsy versus no intervention following shock wave lithotripsy
Comparison 2. Percussion, diuresis, and inversion plus shock wave lithotripsy therapy versus shock wave lithotripsy alone

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Stone‐free rate Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

2 Stone burden reduction Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Totals not selected

3 Complications Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

Figures and Tables -
Comparison 2. Percussion, diuresis, and inversion plus shock wave lithotripsy therapy versus shock wave lithotripsy alone