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Table 3 TSR GRADE table: quality in the overall literature pool by TSR components for acupuncture

From: The effectiveness of acupuncture research across components of the trauma spectrum response (tsr): a systematic review of reviews

TSR component Total number of reviews Number of studies (total number of participants) Confidence in the results Safety GRADE GRADE recommendation
Chronic pain 25 163 (12,675)a Acupuncture promising, but no conclusions yet +1c weak recommendation in favor
Sleep disturbance 6 83 (9,623)b Acupuncture promising, but no conclusions yet +1c weak recommendation in favor
Depression 6 73 (9,986) Acupuncture promising, but no conclusions yet 0c weak recommendation in favor
Headache 5 53 (8,274)b Acupuncture shown to be effective 0c weak recommendation in favor
Anxiety 1 10 (1,201) Acupuncture promising, but no conclusions yet 0 weak recommendation in favor
Substance abuse 7 48 (7,433)b Acupuncture shown to be not effective +1c weak recommendation against
Cognitive function 1 10 (960) Unable to interpret/contradictory results N/Ac no recommendation
Fatigue 1 31 (1,826) Unable to interpret/contradictory results +1 no recommendation
  1. NOTE: Studies included within each review were de-duplicated. Because there was some discrepancy between reviews in how they reported their total number of participants, it is possible that the number of participants is slightly inaccurate; for purposes of this review, all studies were included as reported in each review; anumber of participants not described in two studies; bnumber of participants not described in one study; cstudies that did not report on adverse events were not included in the safety grade.
  2. There are three major domains that comprise the core of the modified GRADE methodology: 1) Confidence in the results was categorized into the following groups using pre-defined criteria: (1) Acupuncture shown to be effective: the majority of the results are of high quality and all show positive results; or there is a most recent largest review showing positive results of highest quality; (2) Acupuncture promising, but no conclusions yet: mix of positive and inconclusive results, but no negative results found among the reviews; the majority of the reviews are of high quality; (3) Unable to interpret/contradictory results: low quality review or the majority of the studies have mixed/inconclusive results; or (4) Acupuncture shown to be not effective: the majority of the reviews report negative results. 2) Safety grade is dependent on the frequency and severity of adverse events and interactions. Safety is categorized into one of the following grades: +2: appears safe with infrequent adverse events and interactions; +1: appears relatively safe but with frequent but not serious adverse events and interactions; 0: safety not well understood or conflicting; -1: appears to have safety concerns that include infrequent but serious adverse events and/or interactions; or −2: has serious safety concerns that include frequent and serious adverse events and/or interactions. 3) Strength of the recommendation can be determined using the following categories and criteria: Strong recommendation in favor of or against: very certain that benefits do, or do not, outweigh risks and burdens; No recommendation: no recommendations can be made; or Weak recommendation in favor of or against: benefits and risks and burdens are finely balanced, or appreciable uncertainty exists about the magnitude of benefits and risks.