Alaranta 1994.

Methods	RCT conducted in Finland
Participants	Workers on social insurance with back pain > 6 months, age 30‐47, less than 2 back surgeries, no contraindications to exercise. 293 patients randomised, 56% female, average age 40.5 years, mean duration of pain not reported
Interventions	MBR (Akseli): 3 weeks daily HEP then 3 weeks inpatient program (42 hours per week). Program: strength training, aerobic training, relaxation, stretching, CBT, discussion groups Physical (control): 3 weeks inpatient program: passive physiotherapy (electrotherapies, massage, traction), muscle training, pool exercises, back school
Outcomes	Disability (Million Pain Disability questionnaire), Work (WHO occupational handicap scale, sick leave days), Utilisation (reduction in physician visits, reduction in physiotherapist visits) Follow‐ups: ST (3 months), LT (12 months)
Notes	Subgroup analyses: High intensity intervention, Low baseline symptom intensity (<60% of maximum scale score). Included in Guzman 2006
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Unclear
Allocation concealment (selection bias)	Unclear risk	Unclear
Blinding of participants	High risk	Not possible
Blinding of clinicians	High risk	Not possible
Blinding of outcome assessment (detection bias) All outcomes	High risk	Not possible; patient reported outcomes
Incomplete outcome data (attrition bias) All outcomes	Low risk	Fig 1. Acceptable 12‐month follow‐up rate 287/293
Intention to treat analysis	Unclear risk	Unclear
Selective reporting (reporting bias)	Unclear risk	No protocol
Comparability of groups at baseline	Low risk	Table 1. Groups similar on symtpom severity, age and work characteristics
Compliance	Unclear risk	Not stated
Cointerventions	Unclear risk	Not stated
Timing of assessment	Low risk	Pg.1341 1st column. "The follow‐up examinations were carried out 3 months and 12 months after the clinical baseline examination"