Review Article

A Systematic Review of Biopsychosocial Training Programs for the Self-Management of Emotional Stress: Potential Applications for the Military

Table 1

Modified SIGN 50 checklist for RCT study design [17].
(a) Section  1: internal validity*

ItemDescription

1.1The study addresses appropriate and clearly focused question.
1.2The assignment of subjects to treatment groups is randomized.
1.5The treatment and control groups are similar at the start of the trial.
1.7All relevant outcomes are measured in a standard, valid and reliable way.
1.8What percentage of subjects in each treatment arm dropped out before the study was completed?
1.9All subjects are analyzed in the groups to which they were randomly allocated (intention to treat analysis).
1.10Where the study is carried out at more than one site, results are comparable for all sites.

Each item in Section  1 is to be evaluated using these criteria: well covered; adequately addressed; poorly addressed; and not applicable (NA) only for question 1.10.
Note that 1.3, 1.4, and 1.6 SIGN criteria were omitted from our modified version of the SIGN as they did not apply to our research question/population: as there were wide differences in the types of programs assessed. Note that all criteria were weighted according to a revised SIGN quality score as reflected below consistently.
(b) Section  2: overall assessment

How well was the study done to minimize bias? How valid is the study? Score options: ++, +, and − based on the following (modifications to SIGN criteria in italics).

++All or most of the criteria have been fulfilled. Where they have not been fulfilled, the conclusions of the study are thought “very unlikely” to alter. An article receives this score if there are 0 criteria scored as poorly addressed.
+Some of the criteria have been fulfilled. Those criteria that have not been fulfilled or not adequately described are thought “unlikely” to alter the conclusions. An article receives this score if 1-2 criteria are scored poorly addressed.
Few or no criteria fulfilled. The conclusions of the study are thought “likely or very likely” to alter. An article receives this score if more than 2 criteria are scored as poorly addressed.

SIGN 50 network: a guideline developer’s handbook http://www.sign.ac.uk/guidelines/fulltext/50/checklist2.html.