Rehabilitation after lumbar spine surgery in adults: a systematic review with meta-analysis

Table 4 GRADE assessment: supervised exercise compared to no treatment

Supervised exercise compared to advice for patients after surgery for lumbar disk herniation Patient or population: patients after surgery for lumbar disk herniation Setting: Intervention: supervised exercise Comparison: no treatment
Outcomes	№ of participants studies) Follow-up	Certainty of the evidence (GRADE)	Relative effect (95% CI)	Anticipated absolute effects
Outcomes	№ of participants studies) Follow-up	Certainty of the evidence (GRADE)	Relative effect (95% CI)	Risk with nonsupervised exercise	Risk difference with supervised exercise
Pain assessed with: Visual Analogue Scale Scale from: 0 to 10 follow-up: mean 3 months	166 (2 RCTs)	⨁◯◯◯ Very low^a,b	-		MD 0.34 lower (7.32 lower to 6.63 higher)
Disability follow-up: mean 3 months	166 (2 RCTs)	⨁◯◯◯ Very low^a,b	-	-	SMD 0.11 SD lower (0.42 lower to 0.19 higher)
Pain assessed with: Visual Analogue Scale Scale from: 0 to 10 follow-up: mean 6 months	166 (2 RCTs)	⨁◯◯◯ Very low^a,b	-		MD 9.28 higher (2.78 higher to 15.77 higher)
Disability follow-up: mean 6 months	166 (2 RCTs)	⨁◯◯◯ Very low^a,b,c	-	-	SMD 0.06 SD lower (0.71 lower to 0.59 higher)

CI confidence interval, MD mean difference, SMD standardised mean difference
GRADE Working Group grades of evidence
High certainty:we are very confident that the true effect lies close to that of the estimate of the effect.
Moderate certainty:we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different.
Low certainty:our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect.
Very low certainty:we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect.
^*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
Explanations
^aall studies at high risk of bias
^bn<<400
^cmoderate heterogeneity, discordant point estimates

ISSN: 2057-0082