| Methods |
Randomised |
| Participants |
59 patients, aged 18 to 60 (median 43 (IQR 35 to 47) and 38 (IQR 31 to 43) years), male and female, who had standard microdiscectomy after a median of 10 (IQR 6 to 24) versus six (IQR 4 to 17) months. Level of surgery: L5‐S1: 30; L4‐5: 26; L2‐3: 2; L3‐4: 1. |
| Interventions |
Both groups: first day after surgery start: stabilisation of the back and hip mobility, activation back, abdominal and buttock muscles, transfers. A written exercise programme to follow at least once a day. Clinic‐based training (I1: n = 29): start three weeks postop: clinic‐based training (including recommended home exercises), exercises, BGA for eight weeks, 1/wk. Home‐based training (I2; n = 30): continue at three weeks postoperative: recommended exercises at home. |
| Outcomes |
Functional status and pain improved but did not differ significantly between groups. Functional status (ODI) post‐treatment, median difference and IQR (I1) ‐20 (‐5 to ‐36) and (I2) ‐20 (‐13 to ‐36), P = 0.49. At 12 months, (I1) ‐23 (‐9 to ‐38) and (I2) ‐32 (‐17 to ‐42), P = 0.09. Leg pain (VAS) post‐treatment (I1) ‐32 (‐14 to ‐71) and (I2) ‐53 (‐23 to ‐77), P = 0.34. At 12 months, (I1) ‐23 (‐11 to ‐67) and (I2) ‐58 (‐32 to ‐80), P = 0.06. |
| Notes |
|
| Risk of bias |
| Bias |
Authors' judgement |
Support for judgement |
| Random sequence generation (selection bias) |
Low risk |
Computer‐generated, blocks of four/methods/participants paragraph four |
| Allocation concealment (selection bias) |
Low risk |
Numbered concealed envelopes/methods/participants paragraph four |
| Blinding (performance bias and detection bias)
All outcomes ‐ patients? |
High risk |
Clinic versus home |
| Blinding (performance bias and detection bias)
All outcomes ‐ care providers? |
High risk |
Clinic versus home |
| Blinding (performance bias and detection bias)
All outcomes ‐ outcome assessors? |
High risk |
Participants not blinded, participant‐reported outcomes |
| Incomplete outcome data (attrition bias)
All outcomes ‐ drop‐outs? |
Low risk |
Missing data at 12 months: one per group, Figure 1 |
| Incomplete outcome data (attrition bias)
All outcomes ‐ ITT analysis? |
High risk |
ITT (statistics paragraph four), Figure 1: missing data |
| Selective reporting (reporting bias) |
Low risk |
No protocol found, ODI and VAS for pain (OM), results and Table 2 |
| Similarity of baseline characteristics? |
Low risk |
Gender, duration, Table 1, ODI, pain, Table 2. Neurological symptoms not reported |
| Co‐interventions avoided or similar? |
High risk |
Healthcare provider home clinic: four to one = 13% to 3% (paragraph on treatment by other healthcare providers) |
| Compliance acceptable? |
Low risk |
25/29 all clinic sessions, 25/30 did home exercises (compliance paragraphs one + two) |
| Timing outcome assessments similar? |
Low risk |
Outcome measures paragraph one: baseline, three, 12 months/Figure 1 |
