{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T07:59:10Z","timestamp":1790150350033,"version":"4.0.1"},"reference-count":36,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T00:00:00Z","timestamp":1789948800000},"content-version":"vor","delay-in-days":20,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["European Journal of Pain"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Blinding is rarely assessed, estimated, or reported in randomised controlled trials (RCTs). To provide contextualised understanding of participant blinding in a placebo\u2010controlled RCT of spinal manipulative therapy (SMT) for chronic primary low back pain (NCT05162924), we aimed to: (i) reassess blinding, (ii) explore treatment effects and adverse events by levels of beliefs, and (iii) examine whether blinding varied by treatment response.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Blinding was assessed immediately after the first intervention session, at the two\u2010 and four\u2010week follow\u2010ups (primary endpoint). The sum Bang blinding index (BI), ranging from \u22122 to 2, was the primary blinding outcome for this secondary analysis. Treatment effects and adverse events were explored in blinded and unblinded participants. BIs were estimated by levels of treatment response after randomisation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of 102 randomised participants, 98 received their intervention as allocated and were included in this secondary analysis. Correct beliefs about intervention assignment in the active SMT group were balanced by incorrect beliefs in the placebo SMT group (\u2018wishful thinking\u2019), suggesting adequate blinding at the study level (sum Bang BI: 0.13 [95% CI, \u22120.22 to 0.48]). Treatment effects were markedly larger in unblinded participants, while adverse events were comparable among blinded and unblinded participants. BIs\u00a0varied by treatment response.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Study\u2010level blinding of participants was adequate in this randomised placebo\u2010controlled trial of SMT. While treatment effects were markedly larger in unblinded participants, adverse events were comparable in blinded and unblinded participants. Blinding varied by treatment response, providing insights for the design and conduct of future trials.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Significance Statement<\/jats:title>\n                    <jats:p>This secondary analysis of blinding in a placebo\u2010controlled RCT of SMT found that blinding at the study level was adequate. Treatment effects were markedly larger in unblinded participants, highlighting the importance of blinding procedures in RCTs. Blinding findings by responder status enhance ongoing discussions regarding the feasibility of blinding in this area. Overall, insights from this secondary analysis encourage the thoughtful consideration of blinding procedures in RCTs of SMT and other physical interventions for pain.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ejp.70370","type":"journal-article","created":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T07:46:06Z","timestamp":1789976766000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Successful Blinding or Wishful Thinking? A Secondary Analysis of a Randomised Controlled Trial of Manual Therapy"],"prefix":"10.1002","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5031-8808","authenticated-orcid":false,"given":"Carlos","family":"Gevers\u2010Montoro","sequence":"first","affiliation":[{"name":"Department of Psychology McGill University  Montreal Quebec Canada"},{"name":"Alan Edwards Centre for Research on Pain McGill University  Montreal Canada"},{"name":"Department of Chiropractic Universit\u00e9 du Qu\u00e9bec \u00e0 Trois\u2010Rivi\u00e8res  Trois\u2010Rivi\u00e8res Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0332-5540","authenticated-orcid":false,"given":"Javier","family":"Mu\u00f1oz Laguna","sequence":"additional","affiliation":[{"name":"Department of Clinical Research University of Bern  Bern Switzerland"},{"name":"Musculoskeletal Epidemiology Research Group University of Zurich and Balgrist University Hospital  Zurich Switzerland"},{"name":"Epidemiology, Biostatistics and Prevention Institute (EBPI) University of Zurich  Zurich Switzerland"},{"name":"University Spine Centre Zurich (UWZH), Balgrist University Hospital, University of Zurich  Zurich Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7257-8122","authenticated-orcid":false,"given":"Cesar A.","family":"Hincapi\u00e9","sequence":"additional","affiliation":[{"name":"Musculoskeletal Epidemiology Research Group University of Zurich and Balgrist University Hospital  Zurich Switzerland"},{"name":"Epidemiology, Biostatistics and Prevention Institute (EBPI) University of Zurich  Zurich Switzerland"},{"name":"University Spine Centre Zurich (UWZH), Balgrist University Hospital, University of Zurich  Zurich Switzerland"},{"name":"Division of Epidemiology, Dalla Lana School of Public Health University of Toronto  Toronto Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4730-0129","authenticated-orcid":false,"given":"Arantxa","family":"Ortega\u2010De Mues","sequence":"additional","affiliation":[{"name":"Fujitega Research Foundation  Madrid Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4171-2226","authenticated-orcid":false,"given":"Mathieu","family":"Pich\u00e9","sequence":"additional","affiliation":[{"name":"Department of Anatomy Universit\u00e9 du Qu\u00e9bec \u00e0 Trois\u2010Rivi\u00e8res  Trois\u2010Rivi\u00e8res Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,21]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.msksp.2019.05.011"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.conctc.2016.05.003"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.3109\/10601331003777444"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cct.2003.10.016"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpain.2013.10.005"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1038\/srep11774"},{"key":"e_1_2_9_8_1","first-page":"CD008112","article-title":"Spinal Manipulative Therapy for Adults With Chronic Low Back Pain","volume":"1","author":"Zoete A.","year":"2026","journal-title":"Cochrane Database of Systematic Reviews"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2665-9913(23)00098-X"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1177\/1740774520984870"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12998-024-00541-4"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2022-065999"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpain.2024.02.014"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.g1687"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1002\/ejp.2205"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj-2022-072108"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj-2024-081123"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1003294"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1097-0258(19960715)15:13<1421::AID-SIM266>3.0.CO;2-H"},{"key":"e_1_2_9_20_1","doi-asserted-by":"crossref","DOI":"10.1136\/bmj-2023-076316","article-title":"The Estimands Framework: A Primer on the ICH E9(R1) Addendum","volume":"384","author":"Kahan B. 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