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Table 2 Appraisal of study validity using the AOTA Evidence Based Project Scale[23]

From: The effectiveness of lasers in the treatment of onychomycosis: a systematic review

Study NHMRC evidence level** Sample size Internal validity Threats to internal validity External validity Threats to external validity
Carney et al. [26] IV C 2 20% attrition b Only DLSO mycosis of the hallux included
Unblinded assessment
Hees et al. [37] III-3 C 1   b Only T Rubrum mycosis included
Hochman [28] IV C 2 Antifungal cream used post intervention. b Type of onychomycosis treated not classified
Variable follow up periods
Hollmig et al. [29] II B 2 Blinding procedures not stated b Type of onychomycosis treated not classified
18% attrition
Kalokasidis et al. [30] IV A 3 Short follow up period OSI results not fully reported b Mainly mild/DLSO mycosis treated
No control group
Kimura et al. [31] III-3 A 3 Variable no. of treatments (1–3) b Mainly DLSO mycosis treated
Turbidity scoring not validated
Landsman et al. [25] II B 2 Smaller control than treatment group b Majority cases mild to moderate mycosis
Industry sponsorship/authorship
Lim et al. [32] IV B 2 Blinding procedures for nail grading not clear. b Majority cases mild to moderate mycosis
Not stated how many finger v. toe nails included
Moon et al. [33] IV C 2 Limited details on nail scoring system validation b Mainly (DLSO) included
Noguichi et al. [34] IV C 2 Limited detail on independence of nail score assessment b Severe nail disease or thick nails excluded - only mild/DLSO cases included
Waibel et al. [35] III-3 B 2 No control/placebo group b Types of mycosis included not reported
Limited detail on how nail clearance assessed and reported
Zhang et al. [36] III-3 B 3 No control/placebo group b Types of mycosis included not reported
Limited detail on how nail clearance assessed
  1. **NHMRC Hierarchy of Evidence adapted from [22].