Mixed-treatment comparison

E Maund; D Craig; S Suekarran; AR Neilson; K Wright; S Brealey; L Dennis; L Goodchild; N Hanchard; A Rangan; G Richardson; J Robertson; C McDaid

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Maund E, Craig D, Suekarran S, et al. Management of Frozen Shoulder: A Systematic Review and Cost-Effectiveness Analysis. Southampton (UK): NIHR Journals Library; 2012 Mar. (Health Technology Assessment, No. 16.11.)

Management of Frozen Shoulder: A Systematic Review and Cost-Effectiveness Analysis.

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Appendix 10Mixed-treatment comparison

Network 1: studies of any intervention (i.e. conservative and invasive) and any quality

Prior: Uniform (0, 0.8)

Comparator: placebo

Treatment	Node no.	SMD

		Mean	95% CrI
Physical therapy without mobilisation	4	−1.71	−2.75 to −0.67^a
Steroid + physiotherapy	6	−1.53	−2.41 to −0.75^a
Electroacupuncture	7	1.36	−2.84 to 0.11
Physiotherapy + placebo	2	−1.22	−1.98 to −0.42^a
Steroid	5	−1.15	−2.03 to −0.26^a
Physiotherapy	3	−0.94	−2.20 to 0.38
MUA + physiotherapy	8	−0.87	−2.44 to 0.78
Sodium hyaluronate	10	−0.21	−1.13 to 0.69
Arthrographic distension + steroid	9	−0.15	−1.19 to 0.90

a: Did not cross line of no effect.
: Data points: 13; residual deviance: 12.72; τ² (between-study variance): 0.17 (95% CrI 0.0004 to 0.58).

Prior: Uniform (0, 2)

Comparator: placebo

Treatment	Node no.	SMD

		Mean	95% CrI
Physical therapy without mobilisation	4	−1.71	−3.27 to −0.15^a
Steroid + physiotherapy	6	−1.57	−2.80 to −0.53^a
Electroacupuncture	7	−1.36	−3.55 to 0.84
Physiotherapy + placebo	2	−1.21	−2.27 to −0.06^a
Steroid	5	−1.14	−2.31 to 0.05
Physiotherapy	3	−0.93	−2.78 to 1.02
MUA + physiotherapy	8	−0.85	−3.24 to 1.63
Sodium hyaluronate	10	−0.21	−1.71 to 1.27
Arthrographic distension + steroid	9	−0.15	−1.70 to 1.41

a: Did not cross line of no effect.
: Data points: 13; residual deviance: 12.59; τ² (between-study variance): 0.46 (95% CrI 0.0004 to 2.62).

Prior: Uniform (0, 10)

Comparator: placebo

Treatment	Node no.	SMD

		Mean	95% CrI
Physical therapy without mobilisation	4	−1.70	−3.46 to 0.06
Steroid + physiotherapy	6	−1.57	−2.93 to −0.42^a
Electroacupuncture	7	−1.35	−3.84 to 1.11
Physiotherapy + placebo	2	−1.21	−2.40 to 0.08
Steroid	5	−1.14	−2.44 to 0.19
Physiotherapy	3	−0.94	−3.03 to 1.26
MUA + physiotherapy	8	−0.86	−3.57 to 1.95
Sodium hyaluronate	10	−0.21	−1.90 to 1.46
Arthrographic distension + steroid	9	−0.14	−1.89 to 1.62

a: Did not cross line of no effect.
: Data points: 13; residual deviance: 12.69; τ² (between-study variance): 0.75 (95% CrI 0.0006 to 4.83).

Prior: Uniform (0, 15)

Comparator: placebo

Treatment	Node no.	SMD

		Mean	95% CrI
Physical therapy without mobilisation	4	−1.71	−3.42 to 0.003
Steroid + physiotherapy	6	−1.57	−2.93 to −0.44^a
Electroacupuncture	7	−1.36	−3.77 to 1.04
Physiotherapy + placebo	2	−1.22	−2.38 to 0.056
Steroid	5	−1.143	−2.45 to 0.17
Physiotherapy	3	−0.94	−2.98 to 1.24
MUA + physiotherapy	8	−0.86	−3.49 to 1.88
Sodium hyaluronate	10	−0.21	−1.87 to 1.45
Arthrographic distension + steroid	9	−0.15	−1.89 to 1.58

a: Did not cross line of no effect.
: Data points: 13; residual deviance: 12.69; τ² (between-study variance): 0.73 (95% CrI 0.0005 to 4.43).

Network 2: studies of any intervention that were of good or satisfactory quality (i.e. method of randomisation was adequate and outcome assessment was blinded)

There were five trials with data that could be used in the analysis of pain at or close to 3 months. Five interventions formed part of a connected network with placebo and the evidence was informed by four trials. The network is presented in Figure 27.

FIGURE 27

Network 2. PT, physical therapy.

Each line represents one comparison, for example there were two studies available for the comparison of steroid with placebo, and one study for the comparison of other physical therapy with placebo.

Prior: Uniform (0, 0.8)

Comparator: placebo

Treatment	Node no.	SMD

		Mean	95% CrI
Steroid + physiotherapy	2	−1.90	−2.79 to −1.02^a
Physical therapy without mobilisation	5	−1.70	−2.66 to −0.75^a
Steroid	3	−1.14	−1.98 to −0.31^a
Physiotherapy + placebo	4	−0.93	−1.75 to −0.12^a
Arthrographic distension + steroid	6	−0.15	−1.09 to 0.80

a: Did not cross line of no effect.
: Data points: 8; residual deviance: 6.30; τ² (between-study variance): 0.13 (95% CrI 0.0002 to 0.5585).

Prior: Uniform (0, 2)

Comparator: placebo

Treatment	Node no.	SMD

		Mean	95% CrI
Steroid + physiotherapy	2	−1.90	−3.06 to −0.78^a
Physical therapy without mobilisation	5	−1.71	−3.15 to −0.29^a
Steroid	3	−1.14	−2.24 to −0.03^a
Physiotherapy + placebo	4	−0.92	−2.03 to 0.16
Arthrographic distension + steroid	6	−0.14	−1.59 to 1.29

a: Did not cross line of no effect.
: Data points: 8; residual deviance: 6.50; τ² (between-study variance): 0.38 (95% CrI 0.0002. to 2.55).

Prior: Uniform (0, 5)

Comparator: placebo

Treatment	Node no.	SMD

		Mean	95% CrI
Steroid + physiotherapy	2	−1.90	−3.24 to −0.61^a
Physical therapy without mobilisation	5	−1.71	−3.43 to 0.002
Steroid	3	−1.14	−2.42 to 0.14
Physiotherapy + placebo	4	−0.93	−2.20 to 0.34
Arthrographic distension + steroid	6	−0.15	−1.87 to 1.55

a: Did not cross line of no effect.
: Data points: 8; residual deviance: 6.47; τ² (between-study variance): 0.70 (95% CrI 0.0002 to 5.8).

Prior: Uniform (0, 10)

Comparator: placebo

Treatment	Node no.	SMD

		Mean	95% CrI
Steroid + physiotherapy	2	−1.909	−3.31 to −0.54^a
Physical therapy without mobilisation	5	−1.705	−3.54 to 0.12
Steroid	3	−1.15	−2.51 to 0.22
Physiotherapy + placebo	4	−0.9271	−2.9 to 0.43
Arthrographic distension + steroid	6	−0.1412	−1.97 to 1.70

a: Did not cross line of no effect.
: Data points: 8; residual deviance: 6.59; τ² (between-study variance): 1.02 (95% CrI 0.0002 to 7.47).

Network 3: studies of conservative treatments of any quality

There were six trials with data that could be used in the analysis of pain at or close to 3 months. Six interventions formed part of a connected network with placebo and the evidence was informed by six trials. The network is presented in Figure 28.

FIGURE 28

Network 3. PT, physical therapy.

Each line represents one comparison, for example there were two studies available for the comparison of steroid with placebo, and one study for the comparison of other physical therapy with placebo.

Prior: Uniform (0, 0.8)

Comparator: placebo

Treatment	Node no.	SMD

		Mean	95% CrI
Physical therapy without mobilisation	6	−1.71	−2.73 to −0.68^a
Steroid + physiotherapy	5	−1.53	−2.40 to −0.75^a
Electroacupuncture	7	−1.36	−2.81 to 0.092
Physiotherapy + placebo	2	−1.22	−1.98 to −0.42^a
Steroid	4	−1.15	−2.02 to −0.27^a
Physiotherapy	3	−0.94	−2.20 to 0.38

a: Did not cross line of no effect.
: Data points: 10; residual deviance: 9.70; τ² (between-study variance): 0.17 (95% CrI 0.0003 to 0.58).

Prior: Uniform (0, 2)

Comparator: placebo

Treatment	Node no.	SMD

		Mean	95% CrI
Physical therapy without mobilisation	6	−1.71	−3.24 to −0.19^a
Steroid + physiotherapy	5	−1.56	−2.77 to −0.54^a
Electroacupuncture	7	−1.36	−3.52 to 0.79
Physiotherapy + placebo	2	−1.21	−2.25 to −0.067^a
Steroid	4	−1.14	−2.31 to 0.034
Physiotherapy	3	−0.92	−2.73 to 1.00

a: Did not cross line of no effect.
: Data points: 10; residual deviance: 9.64; τ² (between-study variance): 0.0.44 (95% CrI 0.0005 to 2.53).

Prior: Uniform (0, 5)

Comparator: placebo

Treatment	Node no.	SMD

		Mean	95% CrI
Physical therapy without mobilisation	6	−1.70	−3.43 to −0.002^a
Steroid + physiotherapy	5	−1.58	−2.92 to −0.46^a
Electroacupuncture	7	−1.35	−3.80 to 1.05
Physiotherapy + placebo	2	−1.21	−2.38 to 0.037
Steroid	4	−1.15	−2.43 to 0.14
Physiotherapy	3	−0.93	−2.98 to 1.21

a: Did not cross line of no effect.
: Data points: 10; residual deviance: 9.65; τ² (between-study variance): 0.65 (95% CrI 0.0004 to 4.29).

Prior: Uniform (0, 10)

Comparator: placebo

Treatment	Node no.	SMD

		Mean	95% CrI
Physical therapy without mobilisation	6	−1.70	−3.43 to 0.059
Steroid + physiotherapy	5	−1.57	−2.92 to −0.43^a
Electroacupuncture	7	−1.35	−3.81 to 1.13
Physiotherapy + placebo	2	−1.21	−2.39 to 0.060
Steroid	4	−1.15	−2.45 to 0.15
Physiotherapy	3	−0.92	−2.99 to 1.25

a: Did not cross line of no effect.
: Data points: 10; residual deviance: 9.61; τ² (between-study variance): 0.72 (95% CrI 0.0004 to 4.54).

Network 4. Network 4: studies of conservative treatments that were of good or satisfactory quality (i.e. method of randomisation was adequate and outcome assessment was blinded)

There were three trials with data that could be used in the analysis of pain at or close to 3 months. Four interventions formed part of a connected network with placebo and the evidence was informed by four trials. The network is presented in Figure 29.

FIGURE 29

Network 4. PT, physical therapy.

Each line represents one comparison, for example there were two studies available for the comparison of steroid with placebo, and one study for the comparison of other physical therapy with placebo.

Prior: Uniform (0, 0.8)

Comparator: placebo

Treatment	Node no.	SMD

		Mean	95% CrI
Steroid + physiotherapy	2	−1.9	−2.79 to −1.02^a
Physical therapy without mobilisation	5	−1.7	−2.66 to −0.76^a
Steroid	3	−1.14	−1.97 to −0.31^a
Physiotherapy + placebo	4	−0.94	−2.66 to −0.76^a

: PT, physical therapy.
a: Did not cross line of no effect.
: Data points: 7; residual deviance: 5.31; τ2 (between-study variance): (95% CrI 0.0002 to 0.56).

Prior: Uniform (0, 2)

Comparator: placebo

Treatment	Node no.	SMD

		Mean	95% CrI
Steroid + physiotherapy	2	−1.911	−3.06 to −0.81^a
Physical therapy without mobilisation	5	−1.706	−3.12 to −0.30^a
Steroid	3	−1.146	−2.23 to −0.06^a
Physiotherapy + placebo	4	−0.9251	−2.01 to 0.14

a: Did not cross line of no effect.
: Data points: 7; residual deviance: 5.44; τ² (between-study variance): 0.36 (95% CrI 0.0002 to 2.54).

Prior: Uniform (0, 5)

Comparator: placebo

Treatment	Node no.	SMD

		Mean	95% CrI
Steroid + physiotherapy	2	−1.912	−3.24 to −0.62^a
Physical therapy without mobilisation	5	−1.71	−3.43 to 0.008
Steroid	3	−1.14	−2.43 to 0.16
Physiotherapy + placebo	4	−0.93	−2.22 to 0.34

a: Did not cross line of no effect.
: Data points: 7; residual deviance: 5.51; τ² (between-study variance): 0.70 (95% CrI 0.0002 to 5.87).

Prior: Uniform (0, 10)

Comparator: placebo

Treatment	Node no.	SMD

		Mean	95% CrI
Steroid + physiotherapy	2	−1.91	−3.35 to −0.54^a
Physical therapy without mobilisation	5	−1.71	−3.55 to 0.14
Steroid	3	−1.15	−2.51 to 0.25
Physiotherapy + placebo	4	−0.93	−2.32 to 0.43

a: Did not cross line of no effect.
: Data points:7; residual deviance: 5.5; τ² (between-study variance): 1.03(95% CrI 0.0002 to 7.64).

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Bookshelf ID: NBK97996

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Maund E, Craig D, Suekarran S, et al. Management of Frozen Shoulder: A Systematic Review and Cost-Effectiveness Analysis. Southampton (UK): NIHR Journals Library; 2012 Mar. (Health Technology Assessment, No. 16.11.) Appendix 10, Mixed-treatment comparison.
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Management of Frozen Shoulder: A Systematic Review and Cost-Effectiveness Analysis.

Appendix 10Mixed-treatment comparison

Network 1: studies of any intervention (i.e. conservative and invasive) and any quality

Network 2: studies of any intervention that were of good or satisfactory quality (i.e. method of randomisation was adequate and outcome assessment was blinded)

FIGURE 27

Network 3: studies of conservative treatments of any quality

FIGURE 28

Network 4. Network 4: studies of conservative treatments that were of good or satisfactory quality (i.e. method of randomisation was adequate and outcome assessment was blinded)

FIGURE 29

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