Ernst 1991.

Methods	Study design: randomised controlled trial Study grouping: parallel group Total number: 61 participants (30 in balneotherapy group and 31 control group) Start date: no details given Duration of participation: 24 days End date: no details given Methods of randomisation: no details given Blinding: mentioned "double‐blind" Power calculation: no details given Losses to follow‐up: no details given Unit of allocation: participants Source of funding: no details given
Participants	Setting: outpatients (second care) Country: Austria Gender: 16 men and 45 women Age (mean): 58.1 (SD 7.4) years Inclusion criteria: people with primary varicosity Exclusion criteria: people with post‐traumatic or post‐thrombotic CVI, lymphoedema, hereditary vascular abnormalities, venous compression syndromes, congestive heart disease, liver and kidney diseases, malignancies, inflammatory diseases, haematological abnormalities, peripheral arterial occlusive disease.
Interventions	Technique: treatment comprised intermittent cold and warm water according to Kneipp therapy (Forestier 2014), or continuous cold‐water treatments, mostly in region of lower legs up to the knees. It was carried 5 days per week and lasted about 12 minutes. Hydrotherapy group: hydrotherapy Control group: no hydrotherapy Duration of follow‐up: 24 days Cointerventions: participants already wearing compression stockings continued to do so.
Outcomes	Outcomes relevant for this review (collected) Oedema (measured by leg volume in millilitres in water plethysmography, by minimal ankle circumference in centimetres and by maximal calf circumference in centimetres) Reported outcomes VFT measured by light reflex rheography Spontaneously related subjective symptoms All outcomes were measured at 12 and 24 days
Identification	Authors name: Edzard Ernst Institution: Department Physical Medicine and Rehabilitation, University of Vienna email: no details given
Notes	We assumed Ernst 1991 and Ernst 1992 were separate studies but were unable to confirm this with the study authors.
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Insufficient information about sequence generation.
Allocation concealment (selection bias)	Unclear risk	Insufficient information about allocation concealment.
Blinding of participants and personnel (performance bias) All outcomes	High risk	Participants and spa physicians not blinded.
Blinding of outcome assessment (detection bias) All outcomes	Low risk	Investigators uninformed as to which study group given participant belonged.
Incomplete outcome data (attrition bias) All outcomes	Unclear risk	No details given.
Selective reporting (reporting bias)	Low risk	All outcomes reported.
Other bias	Unclear risk	No evidence of other bias.