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Considered judgement on quality of evidence

Key question:

Will hyperbaric oxygen therapy reduce autistic behaviors in pediatric

patients compared to no interventions?

Evidence table ref:

1. Volume of evidence

Comment here on any issues concerning the quantity of evidence available on this topic and itsmethodological quality.

The biggest concern I have is the fact that after I have appraised six studies, read two morearticles and three abstracts, because of how the studies were conducted, there is no credibleevidence HBOT works. Most studies had no clearly defined question and simply went on aboutthe background and how wonderful HBOT is. The purpose of those studies was to create enoughstir to have actual studies properly conducted. The individual who conducted almost all of thestudies and wrote almost all of the papers is Dr. Rossingol, who has severe conflict of interests inhis children have autism and he is funded by the International Autism Society. Any other papers

were as poorly done with the obvious main purpose to cloak themselves as a reliable and validstudy whereas the real purpose is to oppose HBOT therapy for autism.

2. ApplicabilityComment here on the extent to which the evidence is directly applicable to the NHS in Scotland.

N/A as per Dr. Saporito February 18, 2013

3. GeneralisabilityComment here on how reasonable it is to generalise from the results of the studies used as

evidence to the target population for this guideline.

In most of the studies the target population was those with autism spectrum disorder. Othersthere was no specific population, only those who are similar: autism spectrum, PDD NOS and

Aspergers.

4. ConsistencyComment here on the degree of consistency demonstrated by the available of evidence. Wherethere are conflicting results, indicate how the group formed a judgement as to the overalldirection of the evidence

The degree of consistency of the evidence is quite consistent in all studies for HBOT state that

more research is needed. The evidence against flat out states it does not work. The resultsbetween the studies were conflicting, which makes be question the reliability of the studies aswell as stringency of methods used. As the studies did not apply appropriate explanations ofmethods; a variety of problems were evident.

5. Clinical impactComment here on the potential clinical impact that the intervention in question might have e.g.size of patient population; magnitude of effect; relative benefit over other management options;resource implications; balance of risk and benefit.

If HBOT only worked in half of the patients:

It would save $30 billion per year.

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Less than 1% of the population ages 3-17 would be affected as opposed to 1% andgrowing at 17% per year. The cost is $3.2 million per person of the lifetime ofautism. This is $3.2 million that will be saved. The current high school graduationrate in the US is 78.2% (2012). Those with autism, only 56% graduate. Withoutautism, an extra 22.2% of people would be more educated in this country and lead toless poverty, less government spending and less waste.

The risk is minimal, showing perhaps skin irritation as the most prudent side effect.

6. Other factorsIndicate here any other factors that you took into account when assessing the evidence base.

I took into account the population, lack of a specific question, lack of p values, lack ofconfounding, reliability and validity

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7. Evidence statementPlease summarise the development group's synthesis of the evidencerelating to this key question, taking all the above factors into account, andindicate the evidence level which applies.

Evidence level

In all of the studies there was no question posed, no control group, no

descriptive method, severe conflict of interests and contradictive numbersbetween studies.

UK National Health

Level C

"Levels ofEvidence".CEBM.Archivedfrom the originalon 2008-04-10

8. RecommendationWhat recommendation(s) does the guideline development group draw fromthis evidence? Please indicate the grade of recommendation(s) and anydissenting opinion within the group.

Grade ofrecommendation

Not to be completed as per instructions of Dr. Saporito- February18, 2013

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