Arbane 2011.

Methods	RCT St George's Hospital, Physiotherapy Department (London, UK)
Participants	N: 53 patients (12 weeks postoperative assessment 44, IG = 23; CG = 21) Sex: 28 male 25 female Mean age: IG = 65.4; CG = 62.6; age range: IG = 47 to 82; CG = 32 to 47) Inclusion criteria: Patients with non‐small cell lung cancer referred for lung resection via open thoracotomy or visual assisted thoracotomy (VATs) Exclusion criteria: Patients undergoing thoracotomy procedure where no lung resection is carried out (e.g. pleurectomy), patients undergoing pneumonectomy, admission greater than 48 hours to Intensive Care Unit postsurgery
Interventions	INTERVENTION: Early exercise intervention. Patients received usual care including pain relief as for the control group, plus twice‐daily additional strength and mobility training from day 1 postoperative through to day 5 postoperative ‐ provided by research physiotherapy staff and consisting of walking, as able, marching on the spot and recumbent bike exercises (carried out at bedside). Within 2 weeks of discharge and once monthly for 3 visits in total (12 weeks postoperative), patients were followed up at home where they were encouraged to continue with their paced exercise programme (usually walking in the park or nearby streets) and an adapted home‐strengthening programme. Home visits were individualised and relevant to patient hobbies (for instance one session was at the golf range for one patient). CONTROL: Control group received all usual care, pain medication as relevant was provided via patient controlled analgesia day 1 postoperative, thereafter orally as relevant. Usual care included routine physiotherapy treatments, airway clearance techniques, mobilisation as able and upper limb activities and was provided at least once daily from day 1 postsurgery. After discharge patients received monthly telephone calls up to 12 weeks from the research team, providing education only.
Outcomes	1. Length of stay and postoperative complications (defined as X‐ray changes reported by radiologist as pneumonia, respiratory complications requiring additional ventilatory support and or necessitating a return to high dependency care) 2. Quality of life (questionnaire EORTC QLQ‐CL13 (version 2.0) 3. Exercise tolerance (6‐Minute Walking Test (6‐MWT)) 4. Quadriceps muscle strength using magnetic stimulation Measured: preoperatively, at 5 days postoperatively and at 12 weeks postoperatively
Notes
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Quote: “Block randomisation. It was performed using computer generated tables after participants had consented and prior to any formal testing.”
Allocation concealment (selection bias)	Low risk	Quote: “The randomisation codes were kept by an independent member of the team and released after consent.”
Blinding	High risk	Quote: “Study was single blinded with the therapist performing assessments unaware of the randomisation although weekend treatments meant that in about 10 participants the same therapist performed the assessment and treatment.”
Incomplete outcome data (attrition bias) All outcomes	Low risk	Causes for withdrawal from the study or of missing data well reported and presented in a “CONSORT flow chart”
Selective reporting (reporting bias)	Low risk	The study protocol is not available but the article presents results on all outcome measures that were pre‐specified in the methods section as relevant
Other bias	Low risk	The study appears to be free of other sources of bias