. 2022 Dec 29;32(2):517–533. doi: 10.1007/s00586-022-07356-y

Table 1.

Characteristics of included studies

Study Year Country	Number of participants Age in years (SD) Pain duration (SD) Pain severity (SD)	Physiotherapy intervention (group G1)	Control intervention (group G2)	Primary outcome measures and time points	Results G1*	Results G2*
Physiotherapy vs. minimal intervention (7 RCTs)
Ferreira et al. [18] 2016 Brazil	N = 60 Age: G1 43.9(14.5) G2 40.3(12.9) Duration: G1 5.8yrs G2 2.0yrs Severity: NPRS (back) G1 5.5 (2.3) G2 5.1 (2.5) NPRS (leg) G1 6.1 (1.6) G2 6.1 (1.9)	Neurodynamic treatment. Passive or active movements. Education on nerve sensitisation. Grade III lumbar foramen opening mobilisations and neurodynamic sliders. Home exercise: one sliding and one tensioning technique.	Both groups advice to remain active, face-to-face. Advised to avoid prolonged rest, do not avoid daily-life activity, do not excessively brace muscles. Advised light activity and movement beneficial for pain.	NPRS (leg) 4w ODI 4w	Pain short 3.7(2.6) ODI short 20 (12)	Pain short 6.1(2.4) ODI short 23 (12)
Fritz et al. [19] 2021 USA	N = 220 Age: G1 40.0(11.2) G2 37.9(11.2) Duration: (days)G1 35.8(25.6) G2 35.9(26.8) Severity: NPRS (back) G1 5.1(1.8) G2 4.8(1.9) NPRS (leg) G1 4.3(2.2) G2 3.8(2.2)	Physical therapy within 3 days of assignment. Exercise and manual therapy in each session. Written directions and instructed to do assigned exercises at home.	Medication and imaging at discretion of primary care provider. Given copy of The Back Book, about favourable prognosis, and importance of remaining active.	NPRS (back) 4w, 6m, 12m ODI 4w, 6m, 12m	Pain short 2.4, (95%CI 2, 2.8) Pain med 2.6, (95%CI 2.2, 3) Pain long 2.3, (95%CI 1.9, 2.7) Disability short 19.9 (95%CI 17.2, 22.7) Disability med 14.5, (95%CI 11.6, 17.3) Disability long 14.4, (95%CI 11.5, 17.4)	Pain short 3.9 (95%CI 3.5, 4.3) Pain med 3.3, (95%CI 2.9, 3.7) Pain long 3.3, (95%CI 2.9, 3.7) Disability short 28.1 (95%CI 25.4, 30.8) Disability med 19.8, (95%CI 17.0, 22.7) Disability long 19.2, (95%CI 16.3, 22.0)
Ghoname et al. [20] 1999 USA	N = 64 Age: G1 43(19) G2 43(19) Duration: (months) 21(9) Severity: NPRS (leg) G1 7 (1.9) G2 6.6 (1.9)	Standard TENS therapy: 4 electrode pads in standardised pattern, stimulated at 4Hz, pulse duration 0.1s. Intensity adjusted to maximum tolerated without producing muscle contractions.	Sham-PENS: placement of 10 acupuncture-like needle probes in identical montage to PENS treatment. However, no electrical stimulation was applied to the probes.	NPRS (leg) 3w VAS physical activity 3w	Pain short 5.4 (1.9) Disability short 4.5 (1.7)	Pain short 6.1 (1.9) Disability 5.5 (2.1)
Hofstee et al. [21] 2003 The Netherlands	N = 250 Age: G1 38(9.5) G2 38(9.5) Duration: (wks)G1 1.8(1.3) G2 1.9(1.2) Severity: VAS G1 60.9 (20.1) G2 65.5 (18.5)	Physiotherapy (exercises, advice, hydrotherapy, home exercise programme).	Continuation of normal activities as much as possible (modify duration, intensity, and frequency according to pain).	Pain VAS 2m, 6m QDS 2m, 6m	Pain short 23.9 (IQR 20,60) Pain med 14.1 (IQR 29,70) Disability short 29.7 (IQR 8.5, 44) Disability med 21.4 (IQR 20,51)	Pain short 23.4 (IQR 17,64) Pain med 12.9 (IQR 26,66) Disability short 31.1 (IQR 10, 42) Disability med 22 (IQR 18,52)
Konstantinovic et al. [22] 2010 Serbia	N = 364 Age: G1 43.5(7.7) G2 41.87 (8.37) Duration: < 4w Severity: (leg) G1 78.5(3.14) G2 74.7(6.05)	Active low-level laser therapy behind involved spine segment using stationary skin-contact method. 5x weekly, total of 15 treatments, frequency 5000Hz, dose 3J/cm²; treatment time 150 seconds.	Placebo laser treatment applied in same manner as active device by identical device that was deactivated by member of Institute for Physics.	VAS leg 3w ODI 3w	Pain short median 34 (IQR 30.5; 38) Disability short median 20 (IQR 19;21)	Pain short median 54 (IQR 50;56) Disability short median 22 (IQR 20;24)
Luijsterburg et al. [23] 2008 The Netherlands	N = 135 Age: G1 42 (10) G2 43 (12) Duration: (inclusion) < 6wks Severity: NRS G1 6.3(2.2) G2 6.3(2.2)	Exercise therapy, advice, guidance: return to activity despite pain, type/content of exercise left to PT. Passive treatment not allowed.	GP care according to clinical guideline, information, advice and, if necessary, pain medication prescribed.	NRS leg 6w, 12w, 12m RDQ 6w, 12w, 12m	Pain short 3.3 (2.67) Pain med 2.4 (2.96) Pain long 1.9 (2.82) Disability short 10.6 (6.67) Disability med 8.2(7.11) Disability long 5.9(6.37)	Pain short 3 (2.67) Pain med 2.6 (2.96) Pain long 2.6 (2.82) Disability short 8.8 (6.67) Disability med 6.9(7.11) Disability long 6.3(6.37)
Santilli et al. [24] 2006 Italy	N = 102 Age: (inclusion) 18 to 65 Duration: (inclusion) < 10d Severity: VAS G1 6.4(0.9) G2 6.4(0.8)	Active manipulations according to protocol by chiropractor including soft tissue manipulations and rotational thrust away from greatest restriction.	Simulated manipulations, soft muscle pressing not specific patterns, not rapid thrusts. Chiropractors as G1.	Local pain reduction 90d, 180d; Radiating pain reduction 90d, 180d; Local pain-free 90d, 180d; Radiating pain-free 90d, 180d.	Pain med (n) radiating pain reduction 48, % pain free 100 Pain long (n) radiating pain reduction 48, % pain free 100	Pain med (n) radiating pain reduction 39, % pain free 81 Pain long (n) radiating pain reduction 40, % pain free 83
Physiotherapy vs. substantial intervention (11 RCTS)
Amundsen et al. [25] 2000 Norway	N = 31 Age: G1 83% 40-70; G2 84% 40-70 Duration not reported Severity: G1 28% mod, 72% severe G2 46% mod, 54% severe	1-month inpatient stay, 3-point hyperextension thoracolumbar brace. Physiotherapy when home, walking and stabilising exercises, kyphotic position encouraged.	Partial/total laminectomy, medial facetectomy/discectomy and/or removal of osteophytes. 1–2 days post-op brace, physiotherapy as previously.	Subjective report 6m, 12m	Pain med (n): No/light 2 (cross 5) Mod 5 (cross 4) Severe 1 (cross 1) Pain long (n): No/light 1 (cross 1); Mod 7 (cross 3); Severe 0 (cross 4)	Pain med (n) No/light 2, Moderate 11, Severe 0 Pain long (n): No/light 5, Moderate 7, Severe 0
Bailey et al. [26] 2020 Canada	N = 128 Age: G1 37.1(11.9) G2 38 (8.3) Duration: (inclusion) 4-12m Severity: VAS back G1 6.5(2.8) G2 6.7(2.6) VAS leg G1 8.0(1.8) G2 7.7(2.0)	Education regarding activity and exercise, use of oral analgesics. Active physiotherapy provided at the discretion of PT. Optional epidural, 2^nd/3^rd injection at discretion of physician.	Microdiscectomy fellowship-trained spine surgeon open/minimal access approach, loupe/microscope assistance.	VAS leg 6m, 12m ODI 6m, 12m	Pain med 5.2 (0.4SE) Pain long 4.7 (0.4SE) Disability med 33.7(2.3SE) Disability long 34.7(2.4SE)	Pain med 2.8 (0.4SE) Pain long 2.6 (0.4SE) Disability med 22.8 (2.3SE) Disability long 22.9 (2.3SE)
Burton et al. [27] 2000 UK	N = 40 Age: 41.9 (10.6) no reports per group Duration not reported Severity: 7 pt scale G1 3.79(1.62) G2 4.05(1.28)	Soft tissue stretching of lumbar/buttock muscles, low-amplitude passive manoeuvres lumbar spine. Clinical discretion re: manipulation. Advice: continue normal activity, encouraged return work.	General anaesthetic, single injection of chymopapain into nucleus of disc and bupivacaine. Discharge following day to usual care of family doctor.	7-point scale back pain 6w, 12m RDQ 6w, 12m	Pain short 2.68 (1.6) Pain long 2.27 (1.53) Disability short 7.79 (6.65) Disability long 5.87 (5.96)	Pain short 3.58 (0.97) Pain long 2.87 (1.36) Disability short 11 (5.69) Disability long 7.27 (6.65)
Erginousakis et al. [28] 2011 Greece	N = 62 Age: G1 36(5.8) G2 38(4.2) Duration not reported Severity: NVS G1 6.9(1.9) G2 7.4 (1.4)	Conservative therapy including education, counselling, physical therapy, NSAIDs, muscle relaxants, analgesics.	Fluoroscopically guided percutaneous disc decompression.	NVS 3m, 12m	Pain short 0.9 (2) Pain long 4 (3.4)	Pain short 3.0 (2.4) Pain long 1.7 (2.4)
McMorland et al. [29] 2010 Canada	N = 40 Age: G1 42.4 G2 41.5 (SD unreported) Duration: (inclusion) > 3m Severity: McGill PRI(R) G1 28.7 (17.4) G2 32.5 (12.9)	Spinal manipulative therapy at discretion of treating clinician, ice or heat, information, education, intro to rehab exercises. Core stability exercise, emphasis on technique.	Surgical microdiscectomy, hospital for 1-2 days. Analgesia for 10 days and advised to avoid heavy lifting, bending or twisting for 6-8 weeks.	McGill PRI(R) 6w RMDQ 6w	Pain short 21.7 (13.7) Disability short 9.5 (6.0)	Pain short 18.4 (16.3) Disability short 9.4 (6.4)
Mondal et al. [30] 2017 India	N = 60 Age: G1 48.38 (6.39) G2 42.11 (8.58) Duration: > 3m Severity: (inclusion) > 5 NRS	Spine extension exercises.	Single transforaminal epidural steroid injection with methylprednisolone acetate (20mg and 0.25% bupivacaine (total 2ml) and spine extension exercises.	NRS 1m ODI 1m	Pain short 5.03 (2.06) Disability short 56.94 (23.8)	Pain short 3.11 (2.06) Disability short 34.79 (23.8)
Nikoobakht et al. [31] 2016 Iran	N = 177 Age: G1 38.0(9.0) G2 37.6(7.3) Duration: (m)G1 25.9(8.6) G2 18.6(12.0) Severity: VAS G1 7.4(1.5) G2 7.6(1.5)	Bed rest, active physical therapy, education & counselling, home exercises, spinal manipulation, analgesics, muscle relaxants, NSAIDs & local injections.	Percutaneous disc decompression under moderate sedation. Graduated return to normal activity in the 2 wks following procedure.	VAS 1m, 3m, 12m ODI 1m, 3m, 12m	Pain short 6.94 (2.27) Pain med 6.6 (2.67) Pain long 6.14 (3.07) Disability short 38.75 (13.27) Disability med 36.76 (15.39) Disability long 35.29 (16.43)	Pain short 5.83 (3.25) Pain med 5.36 (3.43) Pain long 4.68 (3.58) Disability short 28.50 (17.02) Disability med 19.87 (15.49) Disability long 10.84 (12.75)
Osterman et al. [32] 2006 Finland	N = 56 Age: G1 38(7); G2 37(7) Duration (d): G1 60(21); G2 77(32) Severity: VAS G1 57(21); G2 61(20)	Encouraged early physical activity within pain limits, instruction on isometric exercises.	Microdiscectomy within 2 wks of randomisation. Analgesia per individual requirements. Isometric exercise pre and post-op. Active physiotherapy	VAS leg 6w, 6m, 12m ODI 6w, 6m,12m	Pain short 25(27) Pain med 18 (29) Pain long 9 (19) Disability short 22 (16) Disability med 12 (15) Disability long 11(14)	Pain short 12(20) Pain med 9 (20) Pain long 6 (11) Disability short 16 (16) Disability med 8 (12) Disability long 10 (13)
Peul et al. [33] 2007 The Netherlands	N = 283 Age: G1 43.5(9.6) G2 41.7(9.9) Duration: (wks) G1 9.5(2.1) G2 9.4(2.4) Severity: VAS back G1 30.8(27.7) G2 33.8(29.6) VAS leg G1 64.4(21.2) G2 67.2(27.7)	GPs provided prolonged conservative treatment. Informed favourable prognosis, website informed natural course of illness & expectation of recovery. Patients fearful of movement referred to physiotherapy.	Surgery within 2 weeks to remove symptomatic disc herniation. Rehabilitation at home by physiotherapists standardised exercise protocol. Advice to resume activity.	VAS leg 8w, 6m, 12m RDQ 8w, 6m, 12m	Pain short 27.9 (1.9SE) Pain med 14.5 (1.9SE) Pain long 11 (1.9SE) Disability short 9.2 (0.5SE) Disability med 4.8 (0.5SE) Disability long 3.7 (0.5SE)	Pain short 10.2 (1.9SE) Pain med 8.4 (1.9SE) Pain long 11 (1.9SE) Disability short 6.1 (0.5SE) Disability med 4 (0.5SE) Disability long 3.3 (0.5SE)
Weber et al. [34] 1983 Norway	N = 126 Age: G1 41.7 G2 40 (SD not reported) Duration not reported Severity not reported	Wk 1 strict bed rest, moderate isometric exercises, analgesics. Wk 2 partial bed rest, gradual increase in exercise. Group ‘back school’ continued.	Surgical extradural removal of herniated mass of cartilage, out of bed day 1 post-op and discharge home 7-9d post-op without further treatment.	Patient subjective report of improvement as good/fair/poor/bad 12m.	Long term (n): Good 16 (8 cross); Fair 24 (4 cross; Poor 9 (4 cross); Bad 0 (1 cross)	Long term(n): Good 39 (0 cross); Fair 15 (1 cross); Poor 5 (0 cross); Bad 0
Weinstein et al. [35] 2006 USA	N = 501 Age: G1 43(11.3) G2 41.7(11.8) Duration: (inclusion) > 6wks Severity: SF-36 G1 26.7(17.4) G2 27.1(18.5)	Usual care, at least active physical therapy, education/counselling, home exercise, NSAIDs if tolerated. Individualised treatment tracked prospectively.	Standard open discectomy with examination of the involved nerve root. General/local anaesthetic. Nerve root decompressed.	SF-36 3m, 12m ODI 3m, 12m	Pain med 27.6 (1.8SE) Pain long 36.9 (1.8SE) Disability med 25 (1.6SE) Disability long 18.9 (1.6SE)	Pain med 30.5 (1.9SE) Pain long 39.7 (1.8SE) Disability med 21.5 (1.7SE) Disability long 16.9 (1.7SE)

Study
Year
Country

Number of participants
Age in years (SD)
Pain duration (SD)
Pain severity (SD)

Physiotherapy intervention (group G1)

Control intervention (group G2)

Primary outcome measures and time points

Results G1*

Results G2*

Physiotherapy vs. minimal intervention (7 RCTs)

Ferreira et al. [18]

2016

Brazil

N = 60

Age: G1 43.9(14.5) G2 40.3(12.9)

Duration: G1 5.8yrs G2 2.0yrs

Severity: NPRS (back) G1 5.5 (2.3) G2 5.1 (2.5)

NPRS (leg) G1 6.1 (1.6) G2 6.1 (1.9)

Neurodynamic treatment. Passive or active movements. Education on nerve sensitisation. Grade III lumbar foramen opening mobilisations and neurodynamic sliders. Home exercise: one sliding and one tensioning technique.

Both groups advice to remain active, face-to-face. Advised to avoid prolonged rest, do not avoid daily-life activity, do not excessively brace muscles. Advised light activity and movement beneficial for pain.

NPRS (leg) 4w

ODI 4w

Pain short 3.7(2.6)

ODI short 20 (12)

Pain short 6.1(2.4)

ODI short 23 (12)

Fritz et al. [19]

2021

USA

N = 220

Age: G1 40.0(11.2) G2 37.9(11.2)

Duration: (days)G1 35.8(25.6)

G2 35.9(26.8)

Severity: NPRS (back) G1 5.1(1.8) G2 4.8(1.9)

NPRS (leg) G1 4.3(2.2) G2 3.8(2.2)

Physical therapy within 3 days of assignment. Exercise and manual therapy in each session. Written directions and instructed to do assigned exercises at home.

Medication and imaging at discretion of primary care provider. Given copy of The Back Book, about favourable prognosis, and importance of remaining active.

NPRS (back)

4w, 6m, 12m

ODI 4w, 6m, 12m

Pain short 2.4, (95%CI 2, 2.8)

Pain med 2.6, (95%CI 2.2, 3)

Pain long 2.3, (95%CI 1.9, 2.7)

Disability short 19.9 (95%CI 17.2, 22.7)

Disability med 14.5, (95%CI 11.6, 17.3)

Disability long 14.4, (95%CI 11.5, 17.4)

Pain short 3.9 (95%CI 3.5, 4.3)

Pain med 3.3, (95%CI 2.9, 3.7)

Pain long 3.3, (95%CI 2.9, 3.7)

Disability short 28.1 (95%CI 25.4, 30.8)

Disability med 19.8, (95%CI 17.0, 22.7)

Disability long 19.2, (95%CI 16.3, 22.0)

Ghoname et al. [20]

1999

USA

N = 64

Age: G1 43(19) G2 43(19)

Duration: (months) 21(9)

Severity: NPRS (leg) G1 7 (1.9) G2 6.6 (1.9)

Standard TENS therapy: 4 electrode pads in standardised pattern, stimulated at 4Hz, pulse duration 0.1s. Intensity adjusted to maximum tolerated without producing muscle contractions.

Sham-PENS: placement of 10 acupuncture-like needle probes in identical montage to PENS treatment. However, no electrical stimulation was applied to the probes.

NPRS (leg) 3w

VAS physical activity 3w

Pain short 5.4 (1.9)

Disability short 4.5 (1.7)

Pain short 6.1 (1.9)

Disability 5.5 (2.1)

Hofstee et al. [21]

2003

The Netherlands

N = 250

Age: G1 38(9.5) G2 38(9.5)

Duration: (wks)G1 1.8(1.3)

G2 1.9(1.2)

Severity: VAS G1 60.9 (20.1)

G2 65.5 (18.5)

Physiotherapy (exercises, advice, hydrotherapy, home exercise programme).

Continuation of normal activities as much as possible (modify duration, intensity, and frequency according to pain).

Pain VAS 2m, 6m

QDS 2m, 6m

Pain short 23.9 (IQR 20,60)

Pain med 14.1 (IQR 29,70)

Disability short 29.7 (IQR 8.5, 44)

Disability med 21.4 (IQR 20,51)

Pain short 23.4 (IQR 17,64)

Pain med 12.9 (IQR 26,66)

Disability short 31.1 (IQR 10, 42)

Disability med 22 (IQR 18,52)

Konstantinovic et al. [22]

2010

Serbia

N = 364

Age: G1 43.5(7.7) G2 41.87 (8.37)

Duration: < 4w

Severity: (leg) G1 78.5(3.14) G2 74.7(6.05)

Active low-level laser therapy behind involved spine segment using stationary skin-contact method. 5x weekly, total of 15 treatments, frequency 5000Hz, dose 3J/cm²; treatment time 150 seconds.

Placebo laser treatment applied in same manner as active device by identical device that was deactivated by member of Institute for Physics.

VAS leg 3w

ODI 3w

Pain short median 34 (IQR 30.5; 38)

Disability short median 20 (IQR 19;21)

Pain short median 54 (IQR 50;56)

Disability short median 22 (IQR 20;24)

Luijsterburg et al. [23]

2008

The Netherlands

N = 135

Age: G1 42 (10) G2 43 (12)

Duration: (inclusion) < 6wks

Severity: NRS G1 6.3(2.2)

G2 6.3(2.2)

Exercise therapy, advice, guidance: return to activity despite pain, type/content of exercise left to PT. Passive treatment not allowed.

GP care according to clinical guideline, information, advice and, if necessary, pain medication prescribed.

NRS leg

6w, 12w, 12m

RDQ 6w, 12w, 12m

Pain short 3.3 (2.67)

Pain med 2.4 (2.96)

Pain long 1.9 (2.82)

Disability short 10.6 (6.67)

Disability med 8.2(7.11)

Disability long 5.9(6.37)

Pain short 3 (2.67)

Pain med 2.6 (2.96)

Pain long 2.6 (2.82)

Disability short 8.8 (6.67)

Disability med 6.9(7.11)

Disability long 6.3(6.37)

Santilli et al. [24]

2006

Italy

N = 102

Age: (inclusion) 18 to 65

Duration: (inclusion) < 10d

Severity: VAS G1 6.4(0.9)

G2 6.4(0.8)

Active manipulations according to protocol by chiropractor including soft tissue manipulations and rotational thrust away from greatest restriction.

Simulated manipulations, soft muscle pressing not specific patterns, not rapid thrusts. Chiropractors as G1.

Local pain reduction 90d, 180d; Radiating pain reduction 90d, 180d; Local pain-free 90d, 180d; Radiating pain-free 90d, 180d.

Pain med (n) radiating pain reduction 48,

% pain free 100

Pain long (n) radiating pain reduction 48, % pain free 100

Pain med (n) radiating pain reduction 39,

% pain free 81

Pain long (n) radiating pain reduction 40, % pain free 83

Physiotherapy vs. substantial intervention (11 RCTS)

Amundsen et al. [25]

2000

Norway

N = 31

Age: G1 83% 40-70; G2 84% 40-70

Duration not reported

Severity: G1 28% mod, 72% severe

G2 46% mod, 54% severe

1-month inpatient stay, 3-point hyperextension thoracolumbar brace. Physiotherapy when home, walking and stabilising exercises, kyphotic position encouraged.

Partial/total laminectomy, medial facetectomy/discectomy and/or removal of osteophytes. 1–2 days post-op brace, physiotherapy as previously.

Subjective report 6m, 12m

Pain med (n): No/light 2 (cross 5) Mod 5 (cross 4) Severe 1 (cross 1)

Pain long (n): No/light 1 (cross 1); Mod 7 (cross 3); Severe 0 (cross 4)

Pain med (n) No/light 2, Moderate 11, Severe 0

Pain long (n): No/light 5, Moderate 7,

Severe 0

Bailey et al. [26]

2020

Canada

N = 128

Age: G1 37.1(11.9) G2 38 (8.3)

Duration: (inclusion) 4-12m

Severity: VAS back G1 6.5(2.8)

G2 6.7(2.6)

VAS leg G1 8.0(1.8) G2 7.7(2.0)

Education regarding activity and exercise, use of oral analgesics. Active physiotherapy provided at the discretion of PT. Optional epidural, 2^nd/3^rd injection at discretion of physician.

Microdiscectomy fellowship-trained spine surgeon open/minimal access approach, loupe/microscope assistance.

VAS leg 6m, 12m

ODI 6m, 12m

Pain med 5.2 (0.4SE)

Pain long 4.7 (0.4SE)

Disability med 33.7(2.3SE)

Disability long 34.7(2.4SE)

Pain med 2.8 (0.4SE)

Pain long 2.6 (0.4SE)

Disability med 22.8 (2.3SE)

Disability long 22.9 (2.3SE)

Burton et al. [27]

2000

N = 40

Age: 41.9 (10.6) no reports per group

Duration not reported

Severity: 7 pt scale G1 3.79(1.62)

G2 4.05(1.28)

Soft tissue stretching of lumbar/buttock muscles, low-amplitude passive manoeuvres lumbar spine. Clinical discretion re: manipulation. Advice: continue normal activity, encouraged return work.

General anaesthetic, single injection of chymopapain into nucleus of disc and bupivacaine. Discharge following day to usual care of family doctor.

7-point scale back pain 6w, 12m

RDQ 6w, 12m

Pain short 2.68 (1.6)

Pain long 2.27 (1.53)

Disability short 7.79 (6.65)

Disability long 5.87 (5.96)

Pain short 3.58 (0.97)

Pain long 2.87 (1.36)

Disability short 11 (5.69)

Disability long 7.27 (6.65)

Erginousakis et al. [28]

2011

Greece

N = 62

Age: G1 36(5.8) G2 38(4.2)

Duration not reported

Severity: NVS G1 6.9(1.9)

G2 7.4 (1.4)

Conservative therapy including education, counselling, physical therapy, NSAIDs, muscle relaxants, analgesics.

Fluoroscopically guided percutaneous disc decompression.

NVS 3m, 12m

Pain short 0.9 (2)

Pain long 4 (3.4)

Pain short 3.0 (2.4)

Pain long 1.7 (2.4)

McMorland et al. [29]

2010

Canada

N = 40

Age: G1 42.4 G2 41.5 (SD unreported)

Duration: (inclusion) > 3m

Severity: McGill PRI(R) G1 28.7 (17.4) G2 32.5 (12.9)

Spinal manipulative therapy at discretion of treating clinician, ice or heat, information, education, intro to rehab exercises. Core stability exercise, emphasis on technique.

Surgical microdiscectomy, hospital for 1-2 days. Analgesia for 10 days and advised to avoid heavy lifting, bending or twisting for 6-8 weeks.

McGill PRI(R)

RMDQ 6w

Pain short 21.7 (13.7)

Disability short 9.5 (6.0)

Pain short 18.4 (16.3)

Disability short 9.4 (6.4)

Mondal et al. [30]

2017

India

N = 60

Age: G1 48.38 (6.39) G2 42.11 (8.58)

Duration: > 3m

Severity: (inclusion) > 5 NRS

Spine extension exercises.

Single transforaminal epidural steroid injection with methylprednisolone acetate (20mg and 0.25% bupivacaine (total 2ml) and spine extension exercises.

NRS 1m

ODI 1m

Pain short 5.03 (2.06)

Disability short 56.94 (23.8)

Pain short 3.11 (2.06)

Disability short 34.79 (23.8)

Nikoobakht et al. [31]

2016

Iran

N = 177

Age: G1 38.0(9.0) G2 37.6(7.3)

Duration: (m)G1 25.9(8.6) G2 18.6(12.0)

Severity: VAS G1 7.4(1.5) G2 7.6(1.5)

Bed rest, active physical therapy, education & counselling, home exercises, spinal manipulation, analgesics, muscle relaxants, NSAIDs & local injections.

Percutaneous disc decompression under moderate sedation. Graduated return to normal activity in the 2 wks following procedure.

VAS 1m, 3m, 12m

ODI 1m, 3m, 12m

Pain short 6.94 (2.27)

Pain med 6.6 (2.67)

Pain long 6.14 (3.07)

Disability short 38.75 (13.27)

Disability med 36.76 (15.39)

Disability long 35.29 (16.43)

Pain short 5.83 (3.25)

Pain med 5.36 (3.43)

Pain long 4.68 (3.58)

Disability short 28.50 (17.02)

Disability med 19.87 (15.49)

Disability long 10.84 (12.75)

Osterman et al. [32]

2006

Finland

N = 56

Age: G1 38(7); G2 37(7)

Duration (d): G1 60(21); G2 77(32)

Severity: VAS G1 57(21); G2 61(20)

Encouraged early physical activity within pain limits, instruction on isometric exercises.

Microdiscectomy within 2 wks of randomisation. Analgesia per individual requirements. Isometric exercise pre and post-op. Active physiotherapy

VAS leg 6w, 6m, 12m

ODI 6w, 6m,12m

Pain short 25(27)

Pain med 18 (29)

Pain long 9 (19)

Disability short 22 (16)

Disability med 12 (15)

Disability long 11(14)

Pain short 12(20)

Pain med 9 (20)

Pain long 6 (11)

Disability short 16 (16)

Disability med 8 (12)

Disability long 10 (13)

Peul et al. [33]

2007

The Netherlands

N = 283

Age: G1 43.5(9.6) G2 41.7(9.9)

Duration: (wks) G1 9.5(2.1) G2 9.4(2.4)

Severity: VAS back G1 30.8(27.7) G2 33.8(29.6)

VAS leg G1 64.4(21.2)

G2 67.2(27.7)

GPs provided prolonged conservative treatment. Informed favourable prognosis, website informed natural course of illness & expectation of recovery. Patients fearful of movement referred to physiotherapy.

Surgery within 2 weeks to remove symptomatic disc herniation. Rehabilitation at home by physiotherapists standardised exercise protocol. Advice to resume activity.

VAS leg 8w, 6m, 12m

RDQ 8w, 6m, 12m

Pain short 27.9 (1.9SE)

Pain med 14.5 (1.9SE)

Pain long 11 (1.9SE)

Disability short 9.2 (0.5SE)

Disability med 4.8 (0.5SE)

Disability long 3.7 (0.5SE)

Pain short 10.2 (1.9SE)

Pain med 8.4 (1.9SE)

Pain long 11 (1.9SE)

Disability short 6.1 (0.5SE)

Disability med 4 (0.5SE)

Disability long 3.3 (0.5SE)

Weber et al. [34]

1983

Norway

N = 126

Age: G1 41.7 G2 40 (SD not reported)

Duration not reported

Severity not reported

Wk 1 strict bed rest, moderate isometric exercises, analgesics. Wk 2 partial bed rest, gradual increase in exercise. Group ‘back school’ continued.

Surgical extradural removal of herniated mass of cartilage, out of bed day 1 post-op and discharge home 7-9d post-op without further treatment.

Patient subjective report of improvement as good/fair/poor/bad 12m.

Long term (n): Good 16 (8 cross); Fair 24 (4 cross; Poor 9 (4 cross); Bad 0 (1 cross)

Long term(n): Good 39 (0 cross); Fair 15 (1 cross); Poor 5 (0 cross); Bad 0

Weinstein et al. [35]

2006

USA

N = 501

Age: G1 43(11.3) G2 41.7(11.8)

Duration: (inclusion) > 6wks

Severity: SF-36 G1 26.7(17.4) G2 27.1(18.5)

Usual care, at least active physical therapy, education/counselling, home exercise, NSAIDs if tolerated. Individualised treatment tracked prospectively.

Standard open discectomy with examination of the involved nerve root. General/local anaesthetic. Nerve root decompressed.

SF-36 3m, 12m

ODI 3m, 12m

Pain med 27.6 (1.8SE)

Pain long 36.9 (1.8SE)

Disability med 25 (1.6SE)

Disability long 18.9 (1.6SE)

Pain med 30.5 (1.9SE)

Pain long 39.7 (1.8SE)

Disability med 21.5 (1.7SE)

Disability long 16.9 (1.7SE)

RCT randomised controlled trial; G group; SD standard deviation; SE standard error; NPRS numeric pain rating scale; ODI Oswestry disability scale; VAS visual analogue scale; QDS Quebec disability scale; GP general practitioner; RDQ Roland disability scale; NVS numeric visual scale; APS Aberdeen pain scale; McGill PRI(R) McGill pain rating index rank value; TENS transcutaneous electrical nerve stimulation; PENS percutaneous electrical nerve stimulation; PT physiotherapist/physical therapist; IQR interquartile range; CI confidence interval; med medium; cross crossover; m month; wk week; d days

*Data are reported as mean (SD) unless stated otherwise