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Table 5 Quality items and scores of seven studies using transcranial magnetic induced outcome measures included in a systematic review on the effect of spinal manipulation on ‘brain function’

From: Unravelling functional neurology: does spinal manipulation have an effect on the brain? - a systematic literature review

1st Author Yr of publication Ref -Were study subjects in sham controlled studies reported to be blind? (Yes / No / Unclear) -If yes / unclear, was the blinding tested for success? (Yes / No) -If yes, was it successful? (Yes / No) -Were study subjects in studies with control group reported to be naive? (Yes / No / Unclear) -Was the origin of the subjects reported (Yes / No) -If yes, does it allow to exclude any interest? (Yes / No / Unclear) Were study subjects reported to have been randomly allocated to study groups? (Yes / No / Unclear) Were study groups comparable in relation to symptoms when studying symptomatic subjects (duration and pain intensity) (NA when cross-over study design)? (Yes / No) Were the intervention and control(s) well described (at least where and how)? (Yes / No) Was the assessor reported to be blind to group allocation? (Yes / No) Were losses and exclusions of study subjects reported or obvious in result section (including in tables or graphs)? (Yes / No / Unclear) Was the person who statistically analyzed the data reported to be blind to group allocation? (Yes / No) Comments by the technical experts (i) on the statistical analysis, and (ii) in relation to the methodology and/or technical aspects
Quality score (risk of bias, also including an external validity criteria) and classification
Dishman 2002 [17]   -No -Yes -No        2: -MEP methodology does not correspond to standard: no motor threshold, no force control, and lack of random intervals between stimulus -The coil positioning seems not appropriate to lower leg MEPs.
2.5/6 (42%) medium NA = No 0 pt Unclear ("counterbalanced") 0.5 pt NA (healthy subjects) -Yes 0.5 pt -Yes 0.5 pt No 0 pt Yes 1 pt No 0 pt
Haavik-Taylor 2007a [20]   -No -No -NA        1: -The authors stated having used planned comparisons instead of post hoc analysis in order to minimize Type 1 error. However,planned comparisons do not minimize Type1 error. -They mention running a one-way repeated measures ANOVA with the factor “intervention”. However, the degrees of freedom of the F for the result clearly show that authors treated “intervention” as a between-subjects factor, which is not correct.
2/6 (33%) low NA = No 0 pt Yes 1 pt NA (SCP subjects / cross-over) -Yes 0.5 pt -Yes 0.5 pt No 0 pt No 0 pt No 0 pt
Dishman 2008 [18]   -No -Yes -No        2: -MEP methodology is not standard: lack of precise motor threshold, and lack of random intervals between stimulus. -Fig. 1C indicates an inhibition in the time interval prior to SM, which may be responsible for significant differences and relative increase of amplitude after SM.
2/6 (33%) low NA = No 0 pt Yes 1 pt NA (healthy subjects) -Yes 0.5 pt -Yes 0.5 pt No 0 pt No 0 pt No 0 pt
Haavik-Taylor 2008 [23]   -No -No -NA        1: -The authors mention running 2-way ANOVAs for repeated measures with the factors “muscle” and “intervention” were applied to compare the effects of SM on the two different upper limb muscles. However, the degrees of freedom of the F for the results clearly show that authors treated the two factors between-subjects, which is not correct. -They use t tests instead of post-hoc test for testing pairwise comparisons subsequent to the ANOVA. 2: The conclusions are farfetched as assumptions and deduction are made which cannot not be backed by the results.
2/6 (33%) low NA = No 0 pt Yes 1 pt NA (SCP subjects / cross-over) -Yes 0.5 pt -Yes 0.5 pt No 0 pt No 0 pt No 0 pt
Fryer 2012 [16]   -No -Yes -No        2: The coil positioning seems not appropriate to lower leg MEPs.
2.5/6 (42%) medium NA = No 0 pt Yes 1 pt NA (healthy subjects) -Yes 0.5 pt -Yes 0.5 pt No 0 pt Unclear 0.5 pt No 0 pt
Haavik 2016 [24]   -Unclear (most subjects were “novice to chiropractic”) -No -NA        2: -The recruitment curves lack measure of variance. -Feedback from background EMG is lacking, which is a conceptual concern and could explain observed increased in amplitudes.
2/6 (33%) low NA = No 0 pt No 0 pt NA (SCP subjects / cross-over) -Yes 0.5 pt -Yes 0.5 pt No 0 pt Yes 1 pt No 0 pt
Baarbé 2018 [15] -Yes -No -NA         None in relation to statistics No expert was available in relation to the technical aspects of this outcome measure
3.5/6 (58%) medium = Unclear 0.5 pt NA Yes 1 pt NA (SCP subjects) -Yes 0.5 pt -Yes 0.5 pt No 0 pt Yes 1 pt No 0 pt
  1. EMG Electromyography, MEP Motor-evoked potential, NA Not applicable, SCP “subclinical neck/spinal pain”, SM Spinal manipulation