Table 3

Summary of findings and quality of evidence assessment

Summary of findings			Quality of evidence assessment (GRADE)
Outcome	No. of studies	No. of participants	Risk of bias	Inconsistency	Indirectness	Imprecision	Other considerations	Level of evidence	Importance
Depressive symptoms
Pain intensity	14	9466	Very serious*	Very serious†	Very serious‡	Very serious§	Reporting bias detected¶	Very low	Critical
Disability	12	9350	Very serious*	Very serious†	Very serious‡	Very serious§	Reporting bias detected¶	Very low	Critical
Anxiety
Pain intensity	11	6344	Very serious*	Very serious†	Very serious‡	Very serious§	Reporting bias detected¶	Very low	Critical
Disability	8	6169	Very serious*	Very serious†	Very serious‡	Very serious§	Reporting bias detected¶	Very low	Critical
Emotional distress
Pain intensity	7	5336	Very serious*	Very serious†	Very serious‡	Very serious§	Reporting bias detected¶	Very low	Critical
Disability	7	5336	Very serious*	Serious†	Very serious‡	Very serious§	Reporting bias detected¶	Very low	Critical
Self-efficacy
Pain intensity	4	1297	Serious*	Serious†	Very serious‡	Serious§	N/A	Very low	Critical
Disability	3	1240	Serious*	Serious†	Very serious‡	Serious§	N/A	Very low	Critical
Expectations of recovery
Pain intensity	5	1802	Very serious*	Very serious†	Very serious‡	Very serious§	Reporting bias detected¶	Very low	Critical
Disability	7	2115	Very serious*	Very serious†	Very serious‡	Very serious§	Reporting bias detected¶	Very low	Critical
Pain catastrophising
Pain intensity	6	918	Very serious*	Serious†	Serious‡	Very serious§	N/A	Very low	Critical
Disability	4	833	Serious*	Very serious†	Very serious‡	Serious§	Reporting bias detected¶	Very low	Critical

*Randomised trials (lack of allocation concealment; lack of blinding; incomplete accounting of patients and outcomes events; selective outcome reporting bias; other limitations; observational studies (failure to develop and apply appropriate eligibility criteria; flawed measurement of both exposure and outcome; failure to adequate control confounding; incomplete follow-up; non-presence of an unexposed cohort).
†Point estimates vary widely across studies; CIs show minimal or no overlap.
‡ Differences in population, differences in intervention, differences in outcome, indirect comparison.
§ Optimal information size (OIS) criterion is not met and the sample size is small; OIS criterion is met but the 95% CI around an effect does not exclude 1.0 (wide CIs); 95% CI is not reported.
¶ Outcome data not included in the predictive model.
N/A, not available.