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Meta-Analysis
. 2014 Sep 2;2014(9):CD000963.
doi: 10.1002/14651858.CD000963.pub3.

Multidisciplinary biopsychosocial rehabilitation for chronic low back pain

Steven J Kamper  1 , Andreas T Apeldoorn, Alessandro Chiarotto, Rob J E M Smeets, Raymond W J G Ostelo, Jaime Guzman, Maurits W van Tulder
Affiliations
Meta-Analysis

Multidisciplinary biopsychosocial rehabilitation for chronic low back pain

Steven J Kamper et al. Cochrane Database Syst Rev. .

Abstract

Background: Low back pain (LBP) is responsible for considerable personal suffering worldwide. Those with persistent disabling symptoms also contribute to substantial costs to society via healthcare expenditure and reduced work productivity. While there are many treatment options, none are universally endorsed. The idea that chronic LBP is a condition best understood with reference to an interaction of physical, psychological and social influences, the 'biopsychosocial model', has received increasing acceptance. This has led to the development of multidisciplinary biopsychosocial rehabilitation (MBR) programs that target factors from the different domains, administered by healthcare professionals from different backgrounds.

Objectives: To review the evidence on the effectiveness of MBR for patients with chronic LBP. The focus was on comparisons with usual care and with physical treatments measuring outcomes of pain, disability and work status, particularly in the long term.

Search methods: We searched the CENTRAL, MEDLINE, EMBASE, PsycINFO and CINAHL databases in January and March 2014 together with carrying out handsearches of the reference lists of included and related studies, forward citation tracking of included studies and screening of studies excluded in the previous version of this review.

Selection criteria: All studies identified in the searches were screened independently by two review authors; disagreements regarding inclusion were resolved by consensus. The inclusion criteria were published randomised controlled trials (RCTs) that included adults with non-specific LBP of longer than 12 weeks duration; the index intervention targeted at least two of physical, psychological and social or work-related factors; and the index intervention was delivered by clinicians from at least two different professional backgrounds.

Data collection and analysis: Two review authors extracted and checked information to describe the included studies, assessed risk of bias and performed the analyses. We used the Cochrane risk of bias tool to describe the methodological quality. The primary outcomes were pain, disability and work status, divided into the short, medium and long term. Secondary outcomes were psychological functioning (for example depression, anxiety, catastrophising), healthcare service utilisation, quality of life and adverse events. We categorised the control interventions as usual care, physical treatment, surgery, or wait list for surgery in separate meta-analyses. The first two comparisons formed our primary focus. We performed meta-analyses using random-effects models and assessed the quality of evidence using the GRADE method. We performed sensitivity analyses to assess the influence of the methodological quality, and subgroup analyses to investigate the influence of baseline symptom severity and intervention intensity.

Main results: From 6168 studies identified in the searches, 41 RCTs with a total of 6858 participants were included. Methodological quality ratings ranged from 1 to 9 out 12, and 13 of the 41 included studies were assessed as low risk of bias. Pooled estimates from 16 RCTs provided moderate to low quality evidence that MBR is more effective than usual care in reducing pain and disability, with standardised mean differences (SMDs) in the long term of 0.21 (95% CI 0.04 to 0.37) and 0.23 (95% CI 0.06 to 0.4) respectively. The range across all time points equated to approximately 0.5 to 1.4 units on a 0 to 10 numerical rating scale for pain and 1.4 to 2.5 points on the Roland Morris disability scale (0 to 24). There was moderate to low quality evidence of no difference on work outcomes (odds ratio (OR) at long term 1.04, 95% CI 0.73 to 1.47). Pooled estimates from 19 RCTs provided moderate to low quality evidence that MBR was more effective than physical treatment for pain and disability with SMDs in the long term of 0.51 (95% CI -0.01 to 1.04) and 0.68 (95% CI 0.16 to 1.19) respectively. Across all time points this translated to approximately 0.6 to 1.2 units on the pain scale and 1.2 to 4.0 points on the Roland Morris scale. There was moderate to low quality evidence of an effect on work outcomes (OR at long term 1.87, 95% CI 1.39 to 2.53). There was insufficient evidence to assess whether MBR interventions were associated with more adverse events than usual care or physical interventions.Sensitivity analyses did not suggest that the pooled estimates were unduly influenced by the results from low quality studies. Subgroup analyses were inconclusive regarding the influence of baseline symptom severity and intervention intensity.

Authors' conclusions: Patients with chronic LBP receiving MBR are likely to experience less pain and disability than those receiving usual care or a physical treatment. MBR also has a positive influence on work status compared to physical treatment. Effects are of a modest magnitude and should be balanced against the time and resource requirements of MBR programs. More intensive interventions were not responsible for effects that were substantially different to those of less intensive interventions. While we were not able to determine if symptom intensity at presentation influenced the likelihood of success, it seems appropriate that only those people with indicators of significant psychosocial impact are referred to MBR.

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Conflict of interest statement

MvT was involved in the conduct of one of the included studies (Lambeek 2010), and RS was involved in one of the included studies (Smeets 2006/2008). They were not involved in the risk of bias assessment or data extraction.

Figures

1
1
Study flow diagram.
2
2
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
3
3
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
4
4
Funnel plot of comparison: MBR versus physical treatment. Pain short term.
5
5
Funnel plot of comparison: MBR versus physical treatment. Disability short term.
6
6
Funnel plot of comparison: MBR versus physical treatment. Disability long term.
7
7
Forest plot of comparison: 1 Multidisciplinary versus usual care, outcome: 1.1 Back pain short term.
8
8
Forest plot of comparison: 1 Multidisciplinary versus usual care, outcome: 1.2 Back pain medium term.
9
9
Forest plot of comparison: 1 Multidisciplinary versus usual care, outcome: 1.3 Back pain long term.
10
10
Forest plot of comparison: 1 Multidisciplinary versus usual care, outcome: 1.4 Disability short term.
11
11
Forest plot of comparison: 1 Multidisciplinary versus usual care, outcome: 1.5 Disability medium term.
12
12
Forest plot of comparison: 1 Multidisciplinary versus usual care, outcome: 1.6 Disability long term.
13
13
Forest plot of comparison: 1 Multidisciplinary versus usual care, outcome: 1.7 Work short term.
14
14
Forest plot of comparison: 1 Multidisciplinary versus usual care, outcome: 1.8 Work medium term.
15
15
Forest plot of comparison: 1 Multidisciplinary versus usual care, outcome: 1.9 Work long term.
16
16
Forest plot of comparison: 2 Multidisciplinary versus physical treatment, outcome: 2.1 Pain short term.
17
17
Forest plot of comparison: 2 Multidisciplinary versus physical treatment, outcome: 2.2 Pain medium term.
18
18
Forest plot of comparison: 2 Multidisciplinary versus physical treatment, outcome: 2.3 Pain long term.
19
19
Forest plot of comparison: 2 Multidisciplinary versus physical treatment, outcome: 2.4 Disability short term.
20
20
Forest plot of comparison: 2 Multidisciplinary versus physical treatment, outcome: 2.6 Disability long term.
21
21
Forest plot of comparison: 2 Multidisciplinary versus physical treatment, outcome: 2.5 Disability medium term.
22
22
Forest plot of comparison: 2 Multidisciplinary versus physical treatment, outcome: 2.7 Work short term.
23
23
Forest plot of comparison: 2 Multidisciplinary versus physical treatment, outcome: 2.8 Work medium term.
24
24
Forest plot of comparison: 2 Multidisciplinary versus physical treatment, outcome: 2.9 Work long term.
25
25
Forest plot of comparison: 3 Multidisciplinary versus surgery, outcome: 3.1 Pain long term.
26
26
Forest plot of comparison: 3 Multidisciplinary versus surgery, outcome: 3.2 Disability long term.
27
27
Forest plot of comparison: 3 MBR versus surgery, outcome: 3.4 Adverse events/complications.
28
28
Forest plot of comparison: 4 Multidisciplinary versus wait list, outcome: 4.1 Pain short term.
29
29
Forest plot of comparison: 4 Multidisciplinary versus wait list, outcome: 4.2 Disability short term.
1.1
1.1. Analysis
Comparison 1 MBR versus usual care, Outcome 1 Back pain short term.
1.2
1.2. Analysis
Comparison 1 MBR versus usual care, Outcome 2 Back pain medium term.
1.3
1.3. Analysis
Comparison 1 MBR versus usual care, Outcome 3 Back pain long term.
1.4
1.4. Analysis
Comparison 1 MBR versus usual care, Outcome 4 Disability short term.
1.5
1.5. Analysis
Comparison 1 MBR versus usual care, Outcome 5 Disability medium term.
1.6
1.6. Analysis
Comparison 1 MBR versus usual care, Outcome 6 Disability long term.
1.7
1.7. Analysis
Comparison 1 MBR versus usual care, Outcome 7 Work short term.
1.8
1.8. Analysis
Comparison 1 MBR versus usual care, Outcome 8 Work medium term.
1.9
1.9. Analysis
Comparison 1 MBR versus usual care, Outcome 9 Work long term.
1.10
1.10. Analysis
Comparison 1 MBR versus usual care, Outcome 10 QoL SF36 PCS short term.
1.11
1.11. Analysis
Comparison 1 MBR versus usual care, Outcome 11 QoL SF36 MCS short term.
1.12
1.12. Analysis
Comparison 1 MBR versus usual care, Outcome 12 QoL SF36 PCS medium term.
1.13
1.13. Analysis
Comparison 1 MBR versus usual care, Outcome 13 QoL SF36 MCS medium term.
1.14
1.14. Analysis
Comparison 1 MBR versus usual care, Outcome 14 Catastrophising short term.
1.15
1.15. Analysis
Comparison 1 MBR versus usual care, Outcome 15 Catastrophising long term.
1.16
1.16. Analysis
Comparison 1 MBR versus usual care, Outcome 16 Fear avoidance short term.
1.17
1.17. Analysis
Comparison 1 MBR versus usual care, Outcome 17 Fear avoidance long term.
2.1
2.1. Analysis
Comparison 2 MBR versus physical treatment, Outcome 1 Pain short term.
2.2
2.2. Analysis
Comparison 2 MBR versus physical treatment, Outcome 2 Pain medium term.
2.3
2.3. Analysis
Comparison 2 MBR versus physical treatment, Outcome 3 Pain long term.
2.4
2.4. Analysis
Comparison 2 MBR versus physical treatment, Outcome 4 Disability short term.
2.5
2.5. Analysis
Comparison 2 MBR versus physical treatment, Outcome 5 Disability medium term.
2.6
2.6. Analysis
Comparison 2 MBR versus physical treatment, Outcome 6 Disability long term.
2.7
2.7. Analysis
Comparison 2 MBR versus physical treatment, Outcome 7 Work short term.
2.8
2.8. Analysis
Comparison 2 MBR versus physical treatment, Outcome 8 Work medium term.
2.9
2.9. Analysis
Comparison 2 MBR versus physical treatment, Outcome 9 Work long term.
2.10
2.10. Analysis
Comparison 2 MBR versus physical treatment, Outcome 10 QoL short term.
2.11
2.11. Analysis
Comparison 2 MBR versus physical treatment, Outcome 11 Quality of Life medium term.
2.12
2.12. Analysis
Comparison 2 MBR versus physical treatment, Outcome 12 Healthcare visits long term.
2.13
2.13. Analysis
Comparison 2 MBR versus physical treatment, Outcome 13 Depression short term.
2.14
2.14. Analysis
Comparison 2 MBR versus physical treatment, Outcome 14 Depression medium term.
2.15
2.15. Analysis
Comparison 2 MBR versus physical treatment, Outcome 15 Depression long term.
2.16
2.16. Analysis
Comparison 2 MBR versus physical treatment, Outcome 16 Coping short term.
2.17
2.17. Analysis
Comparison 2 MBR versus physical treatment, Outcome 17 Coping medium term.
2.18
2.18. Analysis
Comparison 2 MBR versus physical treatment, Outcome 18 Coping long term.
2.19
2.19. Analysis
Comparison 2 MBR versus physical treatment, Outcome 19 Self‐efficacy short term.
2.20
2.20. Analysis
Comparison 2 MBR versus physical treatment, Outcome 20 Self‐efficacy medium term.
2.21
2.21. Analysis
Comparison 2 MBR versus physical treatment, Outcome 21 Anxiety short term.
2.22
2.22. Analysis
Comparison 2 MBR versus physical treatment, Outcome 22 Anxiety medium term.
3.1
3.1. Analysis
Comparison 3 MBR versus surgery, Outcome 1 Pain long term.
3.2
3.2. Analysis
Comparison 3 MBR versus surgery, Outcome 2 Disability long term.
3.3
3.3. Analysis
Comparison 3 MBR versus surgery, Outcome 3 Work long term.
3.4
3.4. Analysis
Comparison 3 MBR versus surgery, Outcome 4 Adverse events/complications.
3.5
3.5. Analysis
Comparison 3 MBR versus surgery, Outcome 5 QoL SF36 PCS long term.
3.6
3.6. Analysis
Comparison 3 MBR versus surgery, Outcome 6 QoL SF36 MCS long term.
4.1
4.1. Analysis
Comparison 4 MBR versus wait list, Outcome 1 Pain short term.
4.2
4.2. Analysis
Comparison 4 MBR versus wait list, Outcome 2 Disability short term.
4.3
4.3. Analysis
Comparison 4 MBR versus wait list, Outcome 3 Depression short term.
5.1
5.1. Analysis
Comparison 5 MBR versus usual care, sensitivity and subgroup analyses, Outcome 1 Pain short term ‐ all studies.
5.2
5.2. Analysis
Comparison 5 MBR versus usual care, sensitivity and subgroup analyses, Outcome 2 Pain short term ‐ sensitivity and subgroup analyses.
5.3
5.3. Analysis
Comparison 5 MBR versus usual care, sensitivity and subgroup analyses, Outcome 3 Pain medium term ‐ all studies.
5.4
5.4. Analysis
Comparison 5 MBR versus usual care, sensitivity and subgroup analyses, Outcome 4 Pain medium term ‐ sensitivity and subgroup analyses.
5.5
5.5. Analysis
Comparison 5 MBR versus usual care, sensitivity and subgroup analyses, Outcome 5 Pain long term ‐ all studies.
5.6
5.6. Analysis
Comparison 5 MBR versus usual care, sensitivity and subgroup analyses, Outcome 6 Pain long term ‐ sensitivity and subgroup analyses.
5.7
5.7. Analysis
Comparison 5 MBR versus usual care, sensitivity and subgroup analyses, Outcome 7 Disability short term ‐ all analyses.
5.8
5.8. Analysis
Comparison 5 MBR versus usual care, sensitivity and subgroup analyses, Outcome 8 Disability short term ‐ sensitivity and subgroup analyses.
5.9
5.9. Analysis
Comparison 5 MBR versus usual care, sensitivity and subgroup analyses, Outcome 9 Disability medium term ‐ all studies.
5.10
5.10. Analysis
Comparison 5 MBR versus usual care, sensitivity and subgroup analyses, Outcome 10 Disability medium term ‐ sensitivity and subgroup analyses.
5.11
5.11. Analysis
Comparison 5 MBR versus usual care, sensitivity and subgroup analyses, Outcome 11 Disability long term ‐ all studies.
5.12
5.12. Analysis
Comparison 5 MBR versus usual care, sensitivity and subgroup analyses, Outcome 12 Disability long term ‐ sensitivity and subgroup analyses.
5.13
5.13. Analysis
Comparison 5 MBR versus usual care, sensitivity and subgroup analyses, Outcome 13 Work short term ‐ all studies.
5.14
5.14. Analysis
Comparison 5 MBR versus usual care, sensitivity and subgroup analyses, Outcome 14 Work short term ‐ sensitivity and subgroup analyses.
5.15
5.15. Analysis
Comparison 5 MBR versus usual care, sensitivity and subgroup analyses, Outcome 15 Work medium term all studies.
5.16
5.16. Analysis
Comparison 5 MBR versus usual care, sensitivity and subgroup analyses, Outcome 16 Work medium term ‐ sensitivity and subgroup analyses.
5.17
5.17. Analysis
Comparison 5 MBR versus usual care, sensitivity and subgroup analyses, Outcome 17 Work long term ‐ all studies.
5.18
5.18. Analysis
Comparison 5 MBR versus usual care, sensitivity and subgroup analyses, Outcome 18 Work long term ‐ sensitivity and subgroup analyses.
6.1
6.1. Analysis
Comparison 6 MBR versus physical treatment, sensitivity and subgroup analyses, Outcome 1 Pain short term ‐ all studies.
6.2
6.2. Analysis
Comparison 6 MBR versus physical treatment, sensitivity and subgroup analyses, Outcome 2 Pain short term ‐ sensitivity and subgroup analyses.
6.3
6.3. Analysis
Comparison 6 MBR versus physical treatment, sensitivity and subgroup analyses, Outcome 3 Pain medium term ‐ all studies.
6.4
6.4. Analysis
Comparison 6 MBR versus physical treatment, sensitivity and subgroup analyses, Outcome 4 Pain medium term ‐ sensitivity and subgroup analyses.
6.5
6.5. Analysis
Comparison 6 MBR versus physical treatment, sensitivity and subgroup analyses, Outcome 5 Pain long term ‐ all studies.
6.6
6.6. Analysis
Comparison 6 MBR versus physical treatment, sensitivity and subgroup analyses, Outcome 6 Pain long term ‐ sensitivity and subgroup analyses.
6.7
6.7. Analysis
Comparison 6 MBR versus physical treatment, sensitivity and subgroup analyses, Outcome 7 Disability short term ‐ all studies.
6.8
6.8. Analysis
Comparison 6 MBR versus physical treatment, sensitivity and subgroup analyses, Outcome 8 Disability short term ‐ sensitivity and subgroup analyses.
6.9
6.9. Analysis
Comparison 6 MBR versus physical treatment, sensitivity and subgroup analyses, Outcome 9 Disability medium term ‐ all studies.
6.10
6.10. Analysis
Comparison 6 MBR versus physical treatment, sensitivity and subgroup analyses, Outcome 10 Disability medium term ‐ sensitivity and subgroup analyses.
6.11
6.11. Analysis
Comparison 6 MBR versus physical treatment, sensitivity and subgroup analyses, Outcome 11 Disability long term ‐ all studies.
6.12
6.12. Analysis
Comparison 6 MBR versus physical treatment, sensitivity and subgroup analyses, Outcome 12 Disability long term ‐ sensitivity and subgroup analyses.
6.13
6.13. Analysis
Comparison 6 MBR versus physical treatment, sensitivity and subgroup analyses, Outcome 13 Work short term ‐ all studies.
6.14
6.14. Analysis
Comparison 6 MBR versus physical treatment, sensitivity and subgroup analyses, Outcome 14 Work short term ‐ sensitivity and subgroup analyses.
6.15
6.15. Analysis
Comparison 6 MBR versus physical treatment, sensitivity and subgroup analyses, Outcome 15 Work medium term ‐ all studies.
6.16
6.16. Analysis
Comparison 6 MBR versus physical treatment, sensitivity and subgroup analyses, Outcome 16 Work medium term ‐ sensitivity and subgroup analyses.
6.17
6.17. Analysis
Comparison 6 MBR versus physical treatment, sensitivity and subgroup analyses, Outcome 17 Work long term ‐ all studies.
6.18
6.18. Analysis
Comparison 6 MBR versus physical treatment, sensitivity and subgroup analyses, Outcome 18 Work long term ‐ sensitivity and subgroup analyses.
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Update of

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Smeets 2006/2008 {published data only}
    1. Smeets RJ, Severens JL, Beelen S, Vlaeyen JW, Knottnerus JA. More is not always better: cost‐effectiveness analysis of combined, single behavioral and single physical rehabilitation programs for chronic low back pain. European Journal of Pain 2009;13(1):71‐81. - PubMed
    1. Smeets RJEM, Vlaeyen JWS, Hidding A, Kester ADM, Heijden GJMG, Knottnerus JA. Chronic low back pain: Physical training, graded activity with problem solving training, or both? The one‐year post‐treatment results of a randomized controlled trial. Pain 2008;134(8):263‐76. - PubMed
    1. Smeets RJEM, Vlaeyen JWS, Hidding A, Kester ADM, Heijden GJMG, Geel ACM, Knottnerus JA. Active rehabilitation for chronic low back pain: Cognitive‐behavioral, physical, or both? First direct post‐treatment results from a randomized controlled trial. BMC Musculoskeletal Disorders 2006;7:5. - PMC - PubMed
Strand 2001 {published data only}
    1. Strand LI, Ljunggren AE, Haldorsen EMH, Espehaug B. The impact of physical function and pain on work status at 1‐year follow‐up in patients with back pain. Spine 2001;26(7):800‐8. - PubMed
Streibelt 2009 {published data only}
    1. Streibelt M, Thren K, Muller‐Fahrnow W. Effects of FCE‐based multidisciplinary rehabilitation in patients with chronic musculoskeletal disorders ‐ results of a randomized controlled trial [German]. Physikalische Medizin Rehabilitationsmedizin Kurortmedizin 2009;19(1):34‐41.
Tavafian 2008 {published data only}
    1. Tavafian SS, Jamshidi AR, Montazeri A. A randomized study of back school in women with chronic low back pain: quality of life at three, six, and twelve months follow‐up. Spine 2008;33(15):1617‐21. - PubMed
Tavafian 2011 {published data only}
    1. Tavafian SS, Jamshidi AR, Mohammad K. Treatment of chronic low back pain: a randomized clinical trial comparing multidisciplinary group‐based rehabilitation program and oral drug treatment with oral drug treatment alone. Clinical Journal of Pain 2011;27(9):811‐8. - PubMed
Turner 1990 {published data only}
    1. Turner JA, Clancy S, McQuade KJ, Cardenas DD. Effectiveness of behavioral therapy for chronic low back pain: a component analysis. Journal of Consulting and Clinical Psychology 1990;58(5):573‐9. - PubMed
Van den Hout 2003 {published data only}
    1. Hout JHC, Vlaeyen JWS, Heuts PH, Zijlema JH, Wijnen JA. Secondary prevention of work‐related disability in nonspecific low back pain: does problem‐solving therapy help? A randomized clinical trial. Clinical Journal of Pain 2003;19(2):87‐96. - PubMed
Vollenbroek‐Hutten 2004 {published data only}
    1. Vollenbroek‐Hutten MMR, Hermens HJ, Wever D, Gorter M, Rinket J, IJerman MJ. Differences in outcome of a multidisciplinary treatment between subgroups of chronic low back pain patients defined using two multiaxial assessment instruments: the Multidimensional Pain Inventory and lumbar dynamometry. Clinical Rehabilitation 2004;18(5):566‐79. - PubMed
Von Korff 2005 {published data only}
    1. Korff M, Balderson BH, Saunders K, Miglioretti DL, Lin EH, Berry S. A trial of an activating intervention for chronic back pain in primary care and physical therapy settings. Pain 2005;113(3):323‐30. - PubMed

References to studies excluded from this review

Akhmadeeva 2009 {published data only}
    1. Akhmadeeva L, Setchenkova N, Magzhanov R. Effectiveness of transcutaneous dynamic electrical nerve stimulation in low back pain: A pilot randomized controlled trial. Journal of Neurological Sciences 2009;285:S320.
Albaladejo 2010 {published data only}
    1. Albaladejo C, Kovacs FM, Royuela A, Pino R, Zamora J. The efficacy of a short education program and a short physiotherapy program for treating low back pain in primary care: a cluster randomized trial. Spine 2010;35(5):483‐96. - PubMed
Andrade 2008 {published data only}
    1. Andrade SC, Araujo AG, Vilar MJ. [Back school for patients with non‐specific chronic low‐back pain: benefits from the association of an exercise program with patient's education]. [Portuguese]. Acta Reumatologica Portuguesa 2008;33(4):443‐50. - PubMed
Anema 2007 {published data only}
    1. Anema JR, Steenstra IA, Bongers PM, Vet HC, Knol DL, Loisel P, Mechelen W. Multidisciplinary rehabilitation for subacute low back pain: graded activity or workplace intervention or both? A randomized controlled trial. Spine 2007;32(3):291‐300. - PubMed
Angst 2009 {published data only}
    1. Angst F, Verra ML, Lehmann S, Brioschi R, Aeschlimann A. Clinical effectiveness of an interdisciplinary pain management programme compared with standard inpatient rehabilitation in chronic pain: a naturalistic, prospective controlled cohort study. Journal of Rehabilitation Medicine 2009;41(7):569‐75. - PubMed
Bachmann 2009 {published data only}
    1. Bachmann S, Wieser S, Oesch P, Schmidhauser S, Knusel O, Kool J. Three‐year cost analysis of function‐centred versus pain‐centred inpatient rehabilitation in patients with chronic non‐specific low back pain. Journal of Rehabilitation Medicine 2009;41(11):919‐23. - PubMed
Bahrke 2006 {published data only}
    1. Bahrke U, Bandemer‐Greulich U, Fikentscher E, Muller K, Schreiber B, Konzag TA. [Chronic low back pain with endurant pain coping‐‐optimizing rehabilitation success in a hitherto neglected patient group]. [German]. Rehabilitation 2006;45(6):336‐44. - PubMed
Bandemeer‐Greulich 2006 {published data only}
    1. Bandemer‐Greulich U, Schreiber B, Fikentscher E, Bahrke U. Protective and repressive factors for success in rehabilitation of chronic low back pain. [German]. Physikalische Medizin Rehabilitationsmedizin Kurortmedizin 2006;16(5):297‐302.
Bandemeer‐Greulich 2008 {published data only}
    1. Bandemer‐Greulich U, Bosse B, Fikentscher E, Konzag TA, Bahrke U. [Efficacy of psychological interventions on pain coping strategies in orthopedic rehabilitation of chronic low back pain]. [German]. Psychotherapie, Psychosomatik, Medizinische Psychologie 2008;58(1):32‐7. - PubMed
Basler 2007 {published data only}
    1. Basler HD, Bertalanffy H, Quint S, Wilke A, Wolf U. TTM‐based counselling in physiotherapy does not contribute to an increase of adherence to activity recommendations in older adults with chronic low back pain ‐ A randomised controlled trial. European Journal of Pain 11;1:31‐7. - PubMed
Bastiaenen 2004 {published data only}
    1. Bastiaenen CH, Bie RA, Wolters PM, Vlaeyen JW, Bastiaanssen JM, Klabbers AB, et al. Treatment of pregnancy‐related pelvic girdle and/or low back pain after delivery design of a randomized clinical trial within a comprehensive prognostic cohort study. BMC Public Health 2004;4:67. - PMC - PubMed
Becker 2000 {published data only}
    1. Becker N, Sjogren P, Bech P, Olsen AK, Eriksen J. Treatment outcome of chronic non‐malignant pain patients managed in a Danish multidisciplinary pain centre compared to general practice: a randomised controlled trial. Pain 2000;84(2‐3):203‐11. - PubMed
Becker 2008 {published data only}
    1. Becker A, Leonhardt C, Kochen MM, Keller S, Wegscheider K, Baum E, et al. Effects of two guideline implementation strategies on patient outcomes in primary care: a cluster randomized controlled trial. Spine 2008;33(5):473‐80. - PubMed
Bendix 1998a {published data only}
    1. Bendix AF, Bendix T, Haestrup C. Can it be predicted which patients with chronic low back pain should be offered tertiary rehabilitation in a functional restoration program? A search for demographic, socioeconomic, and physical predictors. Spine 1998;23(16):1775‐84. - PubMed
Bethge 2011 {published data only}
    1. Bethge M, Herbold D, Trowitzsch L, Jacobi C. Work status and health‐related quality of life following multimodal work hardening: a cluster randomised trial. Journal of Back and Musculoskeletal Rehabilitation 2011;24(3):161‐72. - PubMed
Binder 2007 {published data only}
    1. Binder A. [Chronic backache with neuropathic component. Individual basic therapy plus multimodal approach]. [German]. MMW Fortschritte der Medizin 2007;149(20):49. - PubMed
Bliokas 2007 {published data only}
    1. Bliokas VV, Cartmill TK, Nagy BJ. Does systematic graded exposure in vivo enhance outcomes in multidisciplinary chronic pain management groups?. Clinical Journal of Pain 2007;23(4):361‐74. - PubMed
Brox 2003 {published data only}
    1. Brox JI, Sorensen R, Friis A, Nygaard O, Indahl A, Keller A, et al. Randomized clinical trial of lumbar instrumented fusion and cognitive intervention and exercises in patients with chronic low back pain and disc degeneration. Spine 2003;17:1913‐21. - PubMed
Buhrman 2011 {published data only}
    1. Buhrman M, Nilsson‐Ihrfeldt E, Jannert M, Strom L, Andersson G. Guided internet‐based cognitive behavioural treatment for chronic back pain reduces pain catastrophizing: a randomized controlled trial. Journal of Rehabilitation Medicine 2011;43(6):500‐5. - PubMed
Bultman 2009 {published data only}
    1. Bultmann U, Sherson D, Olsen J, Hansen CL, Lund T, Kilsgaard J. Coordinated and tailored work rehabilitation: a randomized controlled trial with economic evaluation undertaken with workers on sick leave due to musculoskeletal disorders. Journal of Occupational Rehabilitation 2009;19(1):81‐93. - PubMed
Busch 2011 {published data only}
    1. Busch H, Bodin L, Bergstrom G, Jensen IB. Patterns of sickness absence a decade after pain‐related multidisciplinary rehabilitation. Pain 2011;152(8):1727‐33. - PubMed
Campello 2012 {published data only}
    1. Campello M, Ziemke G, Hiebert R, Weiser S, Brinkmeyer M, Fox B, et al. Implementation of a multidisciplinary program for active duty personnel seeking care for low back pain in a U.S. Navy Medical Center: a feasibility study. Military Medicine 2012;177(9):1075‐80. - PubMed
Cecchi 2012 {published data only}
    1. Cecchi F, Negrini S, Pasquini G, Paperini A, Conti AA, Chiti M, et al. Predictors of functional outcome in patients with chronic low back pain undergoing back school, individual physiotherapy or spinal manipulation. European Journal of Physical and Rehabilitation Medicine 2012;48(3):371‐8. - PubMed
Christiansen 2010 {published data only}
    1. Christiansen S, Oettingen G, Dahme B, Klinger R. A short goal‐pursuit intervention to improve physical capacity: a randomized clinical trial in chronic back pain patients. Pain 2010;149(3):444‐52. - PubMed
Demoulin 2006 {published data only}
    1. Demoulin C, Maquet D, Tomasella M, Croisier J, Crielaard J, Vanderthommen M. Benefits of a physical training program after back to school for chronic low back pain patients. Journal of Musculoskeletal Pain 2006;14(2):21‐31.
Dibbelt 2006 {published data only}
    1. Dibbelt S, Greitemann B, Schel C. Long‐term efficiency of orthopedic rehabilitation in chronic back pain ‐‐ the integrative orthopedic psychosomatic concept (IopKo) [German]. Rehabilitation 2006;45(6):324‐35. - PubMed
Dobscha 2009 {published data only}
    1. Dobscha SK, Corson K, Perrin NA, Hanson GC, Leibowitz RQ, Doak MN, et al. Collaborative care for chronic pain in primary care: a cluster randomized trial. JAMA 2009;301(12):1242‐52. - PubMed
Donzelli 2006 {published data only}
    1. Donzelli S, Domenica F, Cova AM, Galletti R, Giunta N. Two different techniques in the rehabilitation treatment of low back pain: A randomized controlled trial. Europa Medicophysica 2006;42(3):205‐10. - PubMed
Driessen 2011a {published data only}
    1. Driessen MT, Proper KI, Anema JR, Knol DL, Bongers PM, Beek AJ. Participatory ergonomics to reduce exposure to psychosocial and physical risk factors for low back pain and neck pain: results of a cluster randomised controlled trial. Occupational and Environmental Medicine 2011;68(9):674‐81. - PubMed
Driessen 2011b {published data only}
    1. Driessen MT, Proper KI, Anema JR, Knol DL, Bongers PM, Beek AJ. The effectiveness of participatory ergonomics to prevent low‐back and neck pain ‐ results of a cluster randomized controlled trial. Scandinavian Journal of Work, Environment and Health 2011;37(5):383‐93. - PubMed
Dufour 2010 {published data only}
    1. Dufour N, Thamsborg G, Oefeldt A, Lundsgaard C, Stender S. Treatment of chronic low back pain: a randomized, clinical trial comparing group‐based multidisciplinary biopsychosocial rehabilitation and intensive individual therapist‐assisted back muscle strengthening exercises. Spine 35;5:469‐76. - PubMed
Dysvik 2005 {published data only}
    1. Dysvik E, Natvig GK, Eikeland OJ, Brattberg G. Results of a multidisciplinary pain management program: A 6‐ and 12‐month follow‐up study. Rehabilitation Nursing 2005;30(5):198‐206. - PubMed
Ektor‐Andersen 2008 {published data only}
    1. Ektor‐Andersen J, Ingvarsson E, Kullendorff M, Orbaek P. High cost‐benefit of early team‐based biomedical and cognitive‐behaviour intervention for long‐term pain‐related sickness absence. Journal of Rehabilitation Medicine 40;1:1‐8. - PubMed
Esmer 2010 {published data only}
    1. Esmer G, Blum J, Rulf J, Pier J. Mindfulness‐based stress reduction for failed back surgery syndrome: a randomized controlled trial. Journal of the American Osteopathic Association 2010;110(11):646‐52. - PubMed
Ewert 2009 {published data only}
    1. Ewert T, Limm H, Wessels T, Rackwitz B, Garnier K, Freumuth R, Stucki G. The comparative effectiveness of a multimodal program versus exercise alone for the secondary prevention of chronic low back pain and disability. Physical Medicine and Rehabilitation 2009;1(9):798‐808. - PubMed
Ferrari 2006 {published data only}
    1. Ferrari R, Fipaldini E, Birbaumer N. Individual characteristics and results of biofeedback training and operant treatment in patients with chronic pain. [Italian]. Psicoterapia Cognitiva e Comportamentale 2006;12(2):161‐79.
Friedberg 2010 {published data only}
    1. Friedberg MW. Group cognitive behavioral treatment improves chronic low back pain in a cost‐effective manner. Journal of Clinical Outcomes Management 2010;17(6):7‐9.
Friedrich 1998 {published data only}
    1. Friedrich M, Gittler G, Halberstadt Y, Cermak T, Heiller I. Combined exercise and motivation program: effect on the compliance and level of disability of patients with chronic low back pain: A randomized controlled trial. Archives of Physical Medical Rehabilitation 1998;79:475‐87. - PubMed
Friedrich 2005 {published data only}
    1. Friedrich M, Gittler G, Arendasy M, Friedrich KM. Long‐term effect of a combined exercise and motivational program on the level of disability of patients with chronic low back pain. Spine 2005;30(9):995‐1000. - PubMed
Froholdt 2011 {published data only}
    1. Froholdt A, Holm I, Keller A, Gunderson RB, Reikeraas O, Brox JI. No difference in long‐term trunk muscle strength, cross‐sectional area, and density in patients with chronic low back pain 7 to 11 years after lumbar fusion versus cognitive intervention and exercises. Spine Journal 2011;11(8):718‐25. - PubMed
Froholdt 2012 {published data only}
    1. Froholdt A, Reikeraas O, Holm I, Keller A, Brox JI. No difference in 9‐year outcome in CLBP patients randomized to lumbar fusion versus cognitive intervention and exercises. European Spine Journal 2012;21(12):2531‐8. - PMC - PubMed
Frost 1998 {published data only}
    1. Frost H, Lamb SE, Klaber Moffett JA, Fairbank JC, Moser JS. A fitness programme for patients with chronic low back pain: 2‐year follow‐up of a randomised controlled trial. Pain 1998;75(2‐3):273‐9. - PubMed
Gatchel 2003 {published data only}
    1. Gatchel RJ, Polatin PB, Noe C, Gardea M, Pulliam C, Thompson J. Treatment‐ and cost‐effectiveness of early intervention for acute low‐back pain patients: a one‐year prospective study. Journal of Occupational Rehabilitation 2003;13(1):1‐9. - PubMed
George 2009 {published data only}
    1. George SZ, Teyhen DS, Wu SS, Wright A, Dugan JL, Yang G, et al. Psychosocial education improves low back pain beliefs: results from a cluster randomized clinical trial (NCT00373009). The Journal of Orthopaedic and Sports Physical Therapy 2009;39(1):A30‐1. - PMC - PubMed
George 2010a {published data only}
    1. George SZ, Robinson ME. Patient satisfaction with behavioral physical therapy interventions: secondary analysis from a randomized clinical trial. The Journal of Orthopaedic and Sports Physical Therapy 2010;40(1):A22.
George 2010b {published data only}
    1. George SZ, Wittmer VT, Fillingim RB, Robinson ME. Comparison of graded exercise and graded exposure clinical outcomes for patients with chronic low back pain. The Journal of Orthopaedic and Sports Physical Therapy 2010;40(11):694‐704. - PMC - PubMed
George 2011 {published data only}
    1. George SZ, Childs JD, Teyhen DS, Wu SS, Wright AC, Dugan JL, Robinson ME. Brief psychosocial education, not core stabilization, reduced incidence of low back pain: Results from the Prevention of Low Back Pain in the Military (POLM) cluster randomized trial. BMC Medicine 2011;9:128. - PMC - PubMed
Glattacker 2012 {published data only}
    1. Glattacker M, Heyduck K, Meffert C. Illness beliefs, treatment beliefs and information needs as starting points for patient information‐Evaluation of an intervention for patients with chronic back pain. Patient Education & Counseling 2012;86(3):378‐89. - PubMed
Glombiewski 2010 {published data only}
    1. Glombiewski JA, Hartwich‐Tersek J, Rief W. Two psychological interventions are effective in severely disabled, chronic back pain patients: a randomised controlled trial. International Journal of Behavioral Medicine 2010;17(2):97‐107. - PubMed
Glomsrod 2001 {published data only}
    1. Glomsrod B, Lonn JH, Soukup MG, Bo K, Larsen S. "Active back school", prophylactic management for low back pain: Three‐year follow‐up of a randomized, controlled trial. Journal of Rehabilitation Medicine 2001;33(1):26‐30. - PubMed
Gohner 2006 {published data only}
    1. Gohner W, Schlicht W. Preventing chronic back pain: evaluation of a theory‐based cognitive‐behavioural training programme for patients with subacute back pain. Patient Education & Counseling 2006;64(1‐3):87‐95. - PubMed
Greitemann 2006 {published data only}
    1. Greitemann B, Dibbelt S, Buschel C. [Multidisciplinary orthopedic rehabilitation program in patients with chronic back pain and need for changing job situation ‐‐ long‐term effects of a multimodal, multidisciplinary program with activation and job development]. [German]. Zeitschrift fur Orthopadie und Ihre Grenzgebiete 2006;144(3):255‐66. - PubMed
Hagen 2006 {published data only}
    1. Hagen EM. [Does light mobilization treatment reduce long‐term sick leave for low back pain? ] [Norwegian]. Norsk Epidemiologi 2006;16(2):137‐44.
Hagen 2010 {published data only}
    1. Hagen EM, Odelien KH, Lie SA, Eriksen HR. Adding a physical exercise programme to brief intervention for low back pain patients did not increase return to work. Scandinavian Journal of Public Health 2010;38(7):731‐8. - PubMed
Hallegraeff 2009 {published data only}
    1. Hallegraeff JM, Greef M, Winters JC, Lucas C. Manipulative therapy and clinical prediction criteria in treatment of acute nonspecific low back pain. Perceptual and Motor Skills 2009;108(1):196‐208. - PubMed
Hampel 2009 {published data only}
    1. Hampel P, Graef T, Krohn‐Grimberghe B, Tlach L. Effects of gender and cognitive‐behavioral management of depressive symptoms on rehabilitation outcome among inpatient orthopedic patients with chronic low back pain: A 1 year longitudinal study. European Spine Journal 2009;18(12):1867‐80. - PMC - PubMed
Henchoz 2010a {published data only}
    1. Henchoz Y, Goumoens P, Norberg M, Paillex R, So AK. Role of physical exercise in low back pain rehabilitation: a randomized controlled trial of a three‐month exercise program in patients who have completed multidisciplinary rehabilitation. Spine 2010;35(12):1192‐9. - PubMed
Henchoz 2010b {published data only}
    1. Henchoz Y, Pinget C, Wasserfallen JB, Paillex R, Goumoens P, Norberg M, Kai‐Lik So A. Cost‐utility analysis of a three‐month exercise programme vs usual care following multidisciplinary rehabilitation for chronic low back pain. Journal of Rehabilitation Medicine 2010;42(9):846‐52. - PubMed
Heymans 2006 {published data only}
    1. Heymans MW, Vet HC, Bongers PM, Knol DL, Koes BW, Mechelen W. The effectiveness of high‐intensity versus low‐intensity back schools in an occupational setting: a pragmatic randomized controlled trial. Spine 2006;31(10):1075‐82. - PubMed
Hlobil 2005 {published data only}
    1. Hlobil H, Staal JB, Twisk J, Koke A, Ariens G, Smid T, Mechelen W. The effects of a graded activity intervention for low back pain in occupational health on sick leave, functional status and pain: 12‐Month results of a randomized controlled trial. Journal of Occupational Rehabilitation 2005;15(4):569‐80. - PubMed
Hodselmans 2001 {published data only}
    1. Hodselmans AP, Jaegers SM, Goeken LN. Short‐term outcomes of a back school program for chronic low back pain. Archives of Physical and Medical Rehabilitation 2001;82:1099‐105. - PubMed
Huge 2006 {published data only}
    1. Huge V, Schloderer U, Steinberger M, Wuenschmann B, Schops P, Beyer A, Azad SC. Impact of a functional restoration program on pain and health‐related quality of life in patients with chronic low back pain. Pain Medicine 2006;7(6):501‐8. - PubMed
Jensen 2005 {published data only}
    1. Jensen IB, Bergstrom G, Ljungquist T, Bodin L. A 3‐year follow‐up of a multidisciplinary rehabilitation programme for back and neck pain. Pain 2005;115(3):273‐83. - PubMed
Jensen 2007 {published data only}
    1. Jensen I, Bergstrom G, Bodin L, Ljungquist T, Nygren A. [Effects of rehabilitation after seven years. Evaluation of two rehabilitation programs in Sweden]. [Swedish]. Lakartidningen 2007;103(23):1829‐30. - PubMed
Jensen 2009 {published data only}
    1. Jensen IB, Busch H, Bodin L, Hagberg J, Nygren A, Bergstrom G. Cost effectiveness of two rehabilitation programmes for neck and back pain patients: A seven year follow‐up. Pain 2009;152(3):202‐8. - PubMed
Jensen 2011 {published data only}
    1. Jensen C, Jensen OK, Christiansen DH, Nielsen CV. One‐year follow‐up in employees sick‐listed because of low back pain: randomized clinical trial comparing multidisciplinary and brief intervention. Spine 2011;36(15):1180‐9. - PubMed
Jensen 2012 {published data only}
    1. Jensen, C.Jensen, O. K.Nielsen, C. V. Sustainability of return to work in sick‐listed employees with low‐back pain. Two‐year follow‐up in a randomized clinical trial comparing multidisciplinary and brief intervention. BMC Musculoskeletal Disorders 2012;13:156. - PMC - PubMed
Jensen 2013 {published data only}
    1. Jensen C, Nielsen CV, Jensen O, Petersen K. Cost‐effectiveness and cost‐benefit analyses of a multidisciplinary intervention compared with a brief intervention to facilitate return to work in sick‐listed patients with low back pain. Spine 2013;38(13):1059‐67. - PubMed
Johnson 2013 {published data only}
    1. Johnsen LG, Brinckmann P, Hellum C, Rossvoll I, Leivseth G. Segmental mobility, disc height and patient‐reported outcomes after surgery for degenerative disc disease: a prospective randomised trial comparing disc replacement and multidisciplinary rehabilitation. Bone & Joint Journal 2013;95B(1):81‐9. - PubMed
Kainz 2006 {published data only}
    1. Kainz B, Lich M, Engel E, Ckel WH. Comparison of three outpatient therapy forms for treatment of chronic low back pain ‐‐ findings of a multicentre, cluster randomized study [German]. Rehabilitation 2006;45(2):65‐77. - PubMed
Kolip 2001 {published data only}
    1. Kolip P, Czujek J, Greitemann B, Rosowski E, Schmidt B, Slangen K. ["Zest for life instead of strain of illness" ‐ implementation and evaluation of a programme activating chronic back pain patients in a rehabilitation clinic] [German]. Die Rehabilitation 2001;40(5):267‐74. - PubMed
Kumar 2010 {published data only}
    1. Kumar S, Sharma VP, Shukla R, Dev R. Comparative efficacy of two multimodal treatments on male and female sub‐groups with low back pain. Journal of Back and Musculoskeletal Rehabilitation 2010;23(1):1‐9. - PubMed
Lamb 2010 {published data only}
    1. Lamb SE, Hansen Z, Lall R, Castelnuovo E, Withers EJ, Nichols V, et al. Group cognitive behavioural treatment for low‐back pain in primary care: a randomised controlled trial and cost‐effectiveness analysis. Lancet 2010;75(9718):916‐23. - PubMed
Lang 2003 {published data only}
    1. Lang E, Liebig K, Kastner S, Neundorfer B, Heuschmann P. Multidisciplinary rehabilitation versus usual care for chronic low back pain in the community: effects on quality of life. Spine Journal 2003;3(4):270‐6. - PubMed
Lee 2013 {published data only}
    1. Lee WYA, Lee WCE, Law SW, Lau WKA, Leung SM, Sieh KM, et al. Managing psychosocial contributors in low back pain patients‐‐a randomised controlled trial. Journal of Orthopaedics, Trauma and Rehabilitation 2013;17:46‐51.
Le Gall 2001 {published data only}
    1. Gall S, Ozguler A, Piciotti M, Morel‐Fatio M, Leclerc A, Boureau F. Predictive factors of chronic low‐back pain and evaluation of a multidisciplinary pain management program in a population still in activity. [French]. Archives des Maladies Professionnelles et de Medecine du Travail 2001;62(7):575.
Leon 2009 {published data only}
    1. Leon Mateos L, Jover Jover JA, Abasolo Alcazar L, Loza Santamaria E, Perez Nieto MA, Redondo Delgado MM. Functional recovery in low back pain: Efficacy of an early cognitive behavioral intervention. Arthritis and Rheumatism (Arthritis Care and Research) 2009;61(7):996‐1003. - PubMed
Lindell 2008 {published data only}
    1. Lindell O, Johansson SE, Strender LE. Subacute and chronic, non‐specific back and neck pain: cognitive‐behavioural rehabilitation versus primary care. A randomized controlled trial. BMC Musculoskeletal Disorders 2008;9:172. - PMC - PubMed
Linton 2000 {published data only}
    1. Linton SJ, Andersson T. Can chronic disability be prevented? A randomized trial of a cognitive‐behavior intervention and two forms of information for patients with spinal pain. Spine 2000;25(21):2825‐31. - PubMed
Ljungkvist 2000 {published data only}
    1. Ljungkvist I. Short‐ and long‐term effects of a 12‐week intensive functional restoration programme in individuals work‐disabled by chronic spinal pain. Scandinavian Journal of Rehabilitation Medicine. Supplement 2000;40:1‐14. - PubMed
Loisel 2002 {published data only}
    1. Loisel P, Lemaire J, Poitras S, Durand MJ, Champagne F, Stock S, et al. Cost‐benefit and cost‐effectiveness analysis of a disability prevention model for back pain management: a six year follow up study. Occupational and Environmental Medicine 2002;59(12):807‐15. - PMC - PubMed
Lonn 1999 {published data only}
    1. Lønn JH, Glomsrød B, Soukup MG, Bø K, Larsen S. Active back school: prophylactic management for low back pain. A randomized, controlled, 1‐year follow‐up study. Spine 1999;24(9):865‐71. - PubMed
Mannion 2001 {published data only}
    1. Mannion AF, Müntener M, Taimela S, Dvorak J. Comparison of three active therapies for chronic low back pain: results of a randomized clinical trial with one‐year follow‐up. Rheumatology 2001;40(7):772‐8. - PubMed
Mannion 2013 {published data only}
    1. Mannion AF, Brox JI, Fairbank JCT. Comparison of spinal fusion and nonoperative treatment in patients with chronic low back pain: Long‐term follow‐up of three randomized controlled trials. Spine Journal 2013;11:1438‐48. - PubMed
Martin 2000 {published data only}
    1. Martin C, Carney T, Obonyo T, Lamont L. Setting up a pain management programme. The Ayrshire experience. Scottish Medical Journal 2000;45(2):45‐8. - PubMed
Mattila 2007 {published data only}
    1. Mattila R, Malmivaara A, Kastarinen M, Kivel SL, Nissinen A. The effects of lifestyle intervention for hypertension on low back pain: a randomized controlled trial. Spine 2007;32(26):2943‐7. - PubMed
Meyer 2005 {published data only}
    1. Meyer K, Fransen J, Huwiler H, Uebelhart D, Klipstein A. Feasibility and results of a randomised pilot‐study of a work rehabilitation programme. Journal of Back and Musculoskeletal Rehabilitation 2005;18:67‐78.
Mohr 2009 {published data only}
    1. Mohr B, Krohn‐Grimberghe B, Graf T, Schulze J, Petermann F, Hampel P. [Patients with chronic low back pain: the impact of psychosocial features]. [German]. Rehabilitation 2009;48(5):288‐97. - PubMed
Molde 2003 {published data only}
    1. Molde Hagen E, Grasdal A, Eriksen HR. Does early intervention with a light mobilization program reduce long‐term sick leave for low back pain: a 3‐year follow‐up study. Spine 2003;28(20):2309‐15. - PubMed
Nazzal 2013 {published data only}
    1. Nazzal ME, Saadah MA, Saadah LM, Al‐Omari MA, Al‐Oudat ZA, Nazzal MS, et al. Management options of chronic low back pain. A randomized blinded clinical trial. Neurosciences 2013;18(2):152‐9. - PubMed
Nicholas 2013 {published data only}
    1. Nicholas MK, Asghari A, Blyth FM, Wood BM, Murray R, McCabe R, et al. Self‐management intervention for chronic pain in older adults: A randomised controlled trial. Pain 2013;154(6):824‐35. - PubMed
Niemisto 2005 {published data only}
    1. Niemisto YL, Rissanen P, Sarna S, Lahtinen‐Suopanki T, Lindgren K, Hurri H. Cost‐effectiveness of combined manipulation, stabilizing exercises, and physician consultation compared to physician consultation alone for chronic low back pain: a prospective randomized trial with 2‐year follow‐up. Spine 2005;30(10):1109‐15. - PubMed
Padua 2009 {published data only}
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References to other published versions of this review

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