Table 1.

Evidence statements derived with respect to imposition of restrictions following spinal surgery

Evidence statement	Direct evidencea	Indirect evidenceb
The balance of the available evidence does not support the imposition of post-operative restrictions for discectomy or decompression surgery; what little support is offered comes from theoretical considerations rather than empirical evidence	[6, 18, 35, 36]	[1, 13]
There is limited evidence that activity specific restriction in respect of lifting, pushing, pulling is unnecessary	[42]	[68]
There is a lack of consensus among surgeons in respect of the need for, and the nature and timing of post-operative restrictions	[14, 42; A.H. McGregor et al., submitted for publication]
The available evidence suggests that patients are uncertain about what activities they can or should undertake post-operatively	[7]	[2, 18, 45, 50, 51, 55]
The imposition of post-operative restrictions seems to relate to clinician/patient anxiety/uncertainty		[18]
There is strong evidence that most post-operative restrictions are not necessary	[35–37]
There is strong evidence that most post-operative restrictions delay recovery and return to work	[6, 35, 36]	[13]

^aStudy (or review) specifically addressing the topic

^bStudy (or review) having incidental findings impacting on the topic