OBJECTIVES: To determine whether physiotherapy commenced within the first four weeks post spinal surgery is safe and effective. DATA SOURCES: Electronic databases CINAHL, Medline, AMED, PubMed, Embase and PEDro were searched from the earliest date possible through May 2015. An additional trial was identified through reference list scanning. STUDY SELECTION: Controlled trials evaluating comprehensive physiotherapy rehabilitation commenced within four weeks post operatively compared with a control group receiving no physiotherapy, standard post-operative care, rest or less active physiotherapy or sham physiotherapy following spinal surgery of a musculoskeletal eitiology. Two reviewers independently applied inclusion and exclusion criteria with disagreements discussed until consensus could be reached. Searching identified 3162 potentially relevant articles, of which 4 trials with 250 participants met the inclusion criteria. DATA EXTRACTION: Data were extracted using a predefined data extraction form. Methodological quality of trials was assessed independently by two reviewers using the Downs and Black checklist. Pooled analyses were performed using random-effects model with inverse variance methods to calculate risk differences (RD) and 95% confidence intervals (CI) (dichotomous outcomes) and standardised mean differences (SMDs) and 95% CIs (continuous outcomes). DATA SYNTHESIS: When compared to no or sham physiotherapy, early comprehensive physiotherapy did not increase the risk of adverse events (risk difference -0.01, 95%CI -0.07 to 0.05, I2 = 0%). In addition, there is moderate quality evidence demonstrating a reduction in pain by a moderate and significant amount at 12 weeks (SMD -0.38, 95%CI -0.66 to -0.10, I2 = 0%) and at 12+ months (SMD -0.30, 95%CI -0.59 to -0.02, I2 = 0%). CONCLUSIONS: Early comprehensive physiotherapy commenced within the first four weeks post spinal surgery does not increase the potential for an adverse event and leads to a moderate statistically significant reduction in pain when compared to a control group.

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