The review question was clear and inclusion criteria were clearly defined. Several relevant databases were searched the restriction to studies in English increased the risk of language bias. Little information on the review methods was reported so risks of reviewer error and bias were unclear. Although the studies appeared to be of fairly high quality, the quality assessment tool used did not assess some major areas of quality that are particularly relevant to the RCT design (such as blinding, allocation concealment, and comparability of groups at baseline).
Study details were presented and revealed some clinical and methodological differences across the studies. In particular, the authors acknowledged the variability of study protocols for mobilisation. The forest plots presented showed some heterogeneity among the small selection of included studies, especially for the return to work outcome. No statistical estimate of this heterogeneity was reported and this made it difficult to assess the extent to which the studies differed. Different numbers of patients were reported in the text and characteristics table. Results for re-rupture rates were difficult to interpret on the scale shown on the forest plot. Confidence intervals for some studies were wide and suggested that the results were not very precise.
Uncertainty about the review methods and the synthesis, between-study differences and unclear results for the re-rupture rate outcome suggest that the authors' conclusion may not be reliable.