Taking into learn more account the reported lack of studies on informal social support, within spinal pain populations, the authors decided that there would be no exclusions from the quality assessment. Articles were assessed using the quality

assessment criteria checklist by two reviewers (GW, PC). Thereafter all disagreements were discussed at a consensus meeting and if disagreements were not resolved, a third reviewer (KMD) provided the final judgement. Study information on author, country, study population, sample size, response rate, follow up period (cohort designs only), study design, focus, assessment of spinal pain, assessment of social support, analysis, outcome in relation to social support, findings and strength of reported effect were extracted from the studies. In order to meaningfully apply the information on article quality

to assist in the interpretation of the results (e.g. high quality studies having more weight than a low quality studies) the authors decided to use tertiles (three equal sized groups) to create quality score categories for the included studies: ‘high’, ‘medium’ and ‘low’ quality. A best evidence synthesis was carried out to assess the weight of evidence (Slavin, Selleck 3 MA 1995) using levels of evidence criteria adapted from guidance on qualitative synthesis for randomised controlled trials (RCTs) (van Tulder et al., 2003), and subsequent development for non RCT designs (Licht-Strunk et al., 2007). Table 1 outlines the criteria for the assessment of evidence. To overcome the issue of heterogeneity, studies were combined on study design (occurrence, prognosis, cross-section) and type of social support (emotional,

instrumental, informational, appraisal, network size, frequency of support and satisfaction). The systematic search using the databases resulted in 365 publications (see Fig. 1 for a flow diagram of the TCL review procedure). A further 48 articles were included via additional search strategies (hand search, expert consultation, citation search). Three hundred and fourty-four articles were excluded at the title and abstract screen search stage with a further 52 articles excluded using full text screening. The reasons for exclusion at the full text screening stage were studies solely focusing on employment support, studies on specific spinal pain populations (e.g. spondylolithesis, lumbar stenosis), or populations that focused on chronic pain patients outside of this study’s inclusion criteria (e.g. migraines, fibromyalgia, chronic widespread pain). This resulted in 17 suitable articles included within the review (Blozik et al., 2009, Feleus et al., 2007, Follick et al., 1985, Hurwitz et al., 2006, Isacsson et al., 1995, Khatun et al., 2004, Klapow et al., 1995, Koleck et al., 2006, Larsen and Leboeuf-Yde, 2006, Linton, 2005, Masters et al., 2007, Muramatsu et al., 1997, Power et al.