Patients in the physical therapy group could cross over or switch to surgical decompression at any point during the study period based on shared decision making with their spine surgeons. The study protocol required patients to complete the Short Form-36 Health Survey, which assessed their physical function, at 2 years. Approximately 75% of patients in both groups completed 2-year follow-up, by which point 57% of those in the physical therapy group had switched toreceive surgical decompression. The authors reported ITT analyses as well as additional analyses that tried to estimate efficacy despite the high proportion of crossovers. They concluded that surgical decompression and physical therapy led to similar improvement in physical function scores.The primary clinical question the trial was trying toanswer was, does surgery or physical therapy provide better treatment? Readers may use several key related questions to assess whether an analysis based on ITT principles answers this question of interestㄡ