Scolaris Content Display Scolaris Content Display

Contenido relacionado

Ir a:

Revisiones y protocolos relacionados

Respuestas clínicas Cochrane

Topics

Temas

study flow diagram.
Figuras y tablas -
Figure 1

study flow diagram.

Ir a la figura de la revisiónAbrir en una pestaña nueva

'Risk of bias' summary: review authors' judgements about each 'Risk of bias' item for each included trial.
Figuras y tablas -
Figure 2

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

Ir a la figura de la revisiónAbrir en una pestaña nueva

'Risk of bias' graph: review authors' judgements about each 'Risk of bias' item presented as percentages across all included trials.
Figuras y tablas -
Figure 3

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

Ir a la figura de la revisiónAbrir en una pestaña nueva

Funnel plot of comparison: 1 NSAIDs versus placebo, outcome: 1.1 Change in pain intensity from baseline on 100 mm VAS. Follow‐up ≤ 12 weeks.
Figuras y tablas -
Figure 4

Funnel plot of comparison: 1 NSAIDs versus placebo, outcome: 1.1 Change in pain intensity from baseline on 100 mm VAS. Follow‐up ≤ 12 weeks.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Funnel plot of comparison: 1 NSAIDs versus placebo, outcome: 1.2 Change in disability from baseline.
Figuras y tablas -
Figure 5

Funnel plot of comparison: 1 NSAIDs versus placebo, outcome: 1.2 Change in disability from baseline.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Funnel plot of comparison: 1 NSAIDs versus placebo, outcome: 1.3 Proportion of patients experiencing adverse events. Follow‐up ≤ 16 weeks.
Figuras y tablas -
Figure 6

Funnel plot of comparison: 1 NSAIDs versus placebo, outcome: 1.3 Proportion of patients experiencing adverse events. Follow‐up ≤ 16 weeks.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 1 NSAIDs versus placebo, Outcome 1 Change in pain intensity from baseline on 100 mm VAS. Follow‐up ≤ 16 weeks..
Figuras y tablas -
Analysis 1.1

Comparison 1 NSAIDs versus placebo, Outcome 1 Change in pain intensity from baseline on 100 mm VAS. Follow‐up ≤ 16 weeks..

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 1 NSAIDs versus placebo, Outcome 2 Change in disability from baseline.
Figuras y tablas -
Analysis 1.2

Comparison 1 NSAIDs versus placebo, Outcome 2 Change in disability from baseline.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 1 NSAIDs versus placebo, Outcome 3 Proportion of patients experiencing adverse events. Follow‐up ≤ 16 weeks..
Figuras y tablas -
Analysis 1.3

Comparison 1 NSAIDs versus placebo, Outcome 3 Proportion of patients experiencing adverse events. Follow‐up ≤ 16 weeks..

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 1 NSAIDs versus placebo, Outcome 4 Sensitivity analysis: change in pain intensity from baseline on 100 mm VAS. Follow‐up ≤ 16 weeks..
Figuras y tablas -
Analysis 1.4

Comparison 1 NSAIDs versus placebo, Outcome 4 Sensitivity analysis: change in pain intensity from baseline on 100 mm VAS. Follow‐up ≤ 16 weeks..

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 1 NSAIDs versus placebo, Outcome 5 Sensitivity analysis: change in disability from baseline.
Figuras y tablas -
Analysis 1.5

Comparison 1 NSAIDs versus placebo, Outcome 5 Sensitivity analysis: change in disability from baseline.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 1 NSAIDs versus placebo, Outcome 6 Sensitivity analysis: proportion of patients experiencing adverse events. Follow‐up ≤ 16 weeks..
Figuras y tablas -
Analysis 1.6

Comparison 1 NSAIDs versus placebo, Outcome 6 Sensitivity analysis: proportion of patients experiencing adverse events. Follow‐up ≤ 16 weeks..

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 2 NSAIDs versus other drug treatment, Outcome 1 Proportion of patients experiencing global improvement. Follow‐up ≤ 6 weeks..
Figuras y tablas -
Analysis 2.1

Comparison 2 NSAIDs versus other drug treatment, Outcome 1 Proportion of patients experiencing global improvement. Follow‐up ≤ 6 weeks..

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 2 NSAIDs versus other drug treatment, Outcome 2 Proportion of patients experiencing adverse events. Follow‐up ≤ 6 weeks..
Figuras y tablas -
Analysis 2.2

Comparison 2 NSAIDs versus other drug treatment, Outcome 2 Proportion of patients experiencing adverse events. Follow‐up ≤ 6 weeks..

Ir a la figura de la revisiónAbrir en una pestaña nueva
Summary of findings for the main comparison. NSAIDs for people with chronic low back pain

NSAIDs for people with chronic low back pain compared to placebo

Participant or population: people with chronic low back pain
Settings: General practice and outpatient clinic
Intervention: NSAIDs

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

Number of participants
(trials)

Quality of the evidence
(GRADE)

Assumed risk

Corresponding risk

Control

NSAIDs

Change in pain intensity from baseline
100 mm VAS
Follow‐up: 9 to 112 days

Not estimable

The mean change in pain intensity from baseline in the intervention groups was
6.97 lower
(10.74 to 3.19 lower)

‐

1354
(6 trials)

⊕⊕⊝⊝
low1,2,3

Change in disability from baseline
RDQ 0 to 24
Follow‐up: 4 to 16 weeks

Not estimable

The mean change in disability from baseline in the intervention groups was
0.85 lower
(1.30 to 0.40 lower)

‐

1161
(4 trials)

⊕⊕⊝⊝
low3,4,5

Proportion of participants experiencing adverse events
Follow‐up: 9 to 112 days

Study population

RR 1.04
(0.92 to 1.17)

1354
(6 trials)

⊕⊕⊝⊝
low1,2,3

410 per 1000

427 per 1000
(378 to 480)

Moderate

477 per 1000

496 per 1000
(439 to 558)

Sensitivity analysis: change in pain intensity from baseline
100 mm VAS
Follow‐up: 2 to 16 weeks

Not estimable

The mean sensitivity analysis change in pain intensity from baseline. in the intervention groups was
5.03 lower
(10.37 lower to 0.32 higher)

‐

728
(3 trials)

⊕⊕⊕⊝
moderate6

Sensitivity analysis: change in disability from baseline
RDQ 0 to 24
Follow‐up: 6 to 16 weeks

Not estimable

The mean sensitivity analysis change in disability from baseline in the intervention groups was
0.41 lower
(1.04 lower to 0.23 higher)

‐

654
(2 trials)

⊕⊕⊕⊝
moderate7

Sensitivity analysis: proportion of participants experiencing adverse events. Follow‐up ≤ 16 weeks
Follow‐up: 2 to 16 weeks

Study population

RR 0.93
(0.81 to 1.07)

728
(3 trials)

⊕⊕⊕⊝
moderate6

536 per 1000

498 per 1000
(434 to 573)

Moderate

522 per 1000

485 per 1000
(423 to 559)

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: confidence interval; RR: risk ratio; RDQ: Roland Morris Disability Questionnaire. VAS: Visual Analogue Scale

GRADE Working Group grades of evidence
High quality: further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: we are very uncertain about the estimate.

1Allocation concealment was uncertain in most included trials, and randomization was uncertain in half of the included trials, therefore selection bias is likely. Five out of six trials had high drop‐out rates, so attrition bias is likely, one level downgrade.
2Two out of six trials allowed co‐interventions. Two trials included a 'flare design', one level downgrade.
3See funnel plot: we could not detect publication bias, no downgrade.
4Allocation concealment was uncertain in most included trials. All four trials had high drop‐out rates, so attrition bias is highly likely, one level downgrade.
5One included trial allowed co‐interventions. One trial included a 'flare design', one level downgrade.
6Allocation concealment and randomization were uncertain in all included trials, therefore selection bias is likely. Two out of three included trials had high drop‐out rates, so attrition bias is likely, one level downgrade.
7Allocation concealment and randomization was uncertain in both trials, therefore selection bias is likely. Both trials had high drop‐out rates, so attrition bias is likely, one level downgrade.

Figuras y tablas -
Summary of findings for the main comparison. NSAIDs for people with chronic low back pain
Ir a la tabla de la revisión
Comparison 1. NSAIDs versus placebo

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Change in pain intensity from baseline on 100 mm VAS. Follow‐up ≤ 16 weeks. Show forest plot

6

Mean Difference (IV, Random, 95% CI)

Subtotals only

1.1 All NSAIDs

6

1354

Mean Difference (IV, Random, 95% CI)

‐6.97 [‐10.74, ‐3.19]

1.2 Non‐selective NSAIDs

4

847

Mean Difference (IV, Random, 95% CI)

‐5.96 [‐10.96, ‐0.96]

1.3 Selective NSAIDs

2

507

Mean Difference (IV, Random, 95% CI)

‐9.11 [‐13.56, ‐4.66]

2 Change in disability from baseline Show forest plot

4

1161

Mean Difference (IV, Fixed, 95% CI)

‐0.85 [‐1.30, ‐0.40]

3 Proportion of patients experiencing adverse events. Follow‐up ≤ 16 weeks. Show forest plot

6

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

3.1 All NSAIDs

6

1354

Risk Ratio (M‐H, Fixed, 95% CI)

1.04 [0.92, 1.17]

3.2 Non‐selective NSAIDs

4

847

Risk Ratio (M‐H, Fixed, 95% CI)

0.94 [0.82, 1.08]

3.3 Selective NSAIDs

2

507

Risk Ratio (M‐H, Fixed, 95% CI)

1.25 [1.00, 1.56]

4 Sensitivity analysis: change in pain intensity from baseline on 100 mm VAS. Follow‐up ≤ 16 weeks. Show forest plot

3

728

Mean Difference (IV, Random, 95% CI)

‐5.03 [‐10.37, 0.32]

5 Sensitivity analysis: change in disability from baseline Show forest plot

2

654

Mean Difference (IV, Fixed, 95% CI)

‐0.41 [‐1.04, 0.23]

6 Sensitivity analysis: proportion of patients experiencing adverse events. Follow‐up ≤ 16 weeks. Show forest plot

3

728

Risk Ratio (M‐H, Fixed, 95% CI)

0.93 [0.81, 1.07]
Figuras y tablas -
Comparison 1. NSAIDs versus placebo
Ir a la tabla de la revisión
Comparison 2. NSAIDs versus other drug treatment

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Proportion of patients experiencing global improvement. Follow‐up ≤ 6 weeks. Show forest plot

2

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

2 Proportion of patients experiencing adverse events. Follow‐up ≤ 6 weeks. Show forest plot

3

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected
Figuras y tablas -
Comparison 2. NSAIDs versus other drug treatment
Ir a la tabla de la revisión