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Meta-Analysis
. 2015 Feb 18:350:h444.
doi: 10.1136/bmj.h444.

Multidisciplinary biopsychosocial rehabilitation for chronic low back pain: Cochrane systematic review and meta-analysis

Steven J Kamper  1 , A T Apeldoorn  2 , A Chiarotto  2 , R J E M Smeets  3 , R W J G Ostelo  4 , J Guzman  5 , M W van Tulder  6
Affiliations
Meta-Analysis

Multidisciplinary biopsychosocial rehabilitation for chronic low back pain: Cochrane systematic review and meta-analysis

Steven J Kamper et al. BMJ. .

Abstract

Objective: To assess the long term effects of multidisciplinary biopsychosocial rehabilitation for patients with chronic low back pain.

Design: Systematic review and random effects meta-analysis of randomised controlled trials.

Data sources: Electronic searches of Cochrane Back Review Group Trials Register, CENTRAL, Medline, Embase, PsycINFO, and CINAHL databases up to February 2014, supplemented by hand searching of reference lists and forward citation tracking of included trials.

Study selection criteria: Trials published in full; participants with low back pain for more than three months; multidisciplinary rehabilitation involved a physical component and one or both of a psychological component or a social or work targeted component; multidisciplinary rehabilitation was delivered by healthcare professionals from at least two different professional backgrounds; multidisciplinary rehabilitation was compared with a non- multidisciplinary intervention.

Results: Forty one trials included a total of 6858 participants with a mean duration of pain of more than one year who often had failed previous treatment. Sixteen trials provided moderate quality evidence that multidisciplinary rehabilitation decreased pain (standardised mean difference 0.21, 95% confidence interval 0.04 to 0.37; equivalent to 0.5 points in a 10 point pain scale) and disability (0.23, 0.06 to 0.40; equivalent to 1.5 points in a 24 point Roland-Morris index) compared with usual care. Nineteen trials provided low quality evidence that multidisciplinary rehabilitation decreased pain (standardised mean difference 0.51, -0.01 to 1.04) and disability (0.68, 0.16 to 1.19) compared with physical treatments, but significant statistical heterogeneity across trials was present. Eight trials provided moderate quality evidence that multidisciplinary rehabilitation improves the odds of being at work one year after intervention (odds ratio 1.87, 95% confidence interval 1.39 to 2.53) compared with physical treatments. Seven trials provided moderate quality evidence that multidisciplinary rehabilitation does not improve the odds of being at work (odds ratio 1.04, 0.73 to 1.47) compared with usual care. Two trials that compared multidisciplinary rehabilitation with surgery found little difference in outcomes and an increased risk of adverse events with surgery.

Conclusions: Multidisciplinary biopsychosocial rehabilitation interventions were more effective than usual care (moderate quality evidence) and physical treatments (low quality evidence) in decreasing pain and disability in people with chronic low back pain. For work outcomes, multidisciplinary rehabilitation seems to be more effective than physical treatment but not more effective than usual care.

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Conflict of interest statement

Competing Interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: SJK has received grants from the National Health and Medical Research Council of Australia; RJEMS is a member of a scientific advisory board for Philips Pain Management; RWJGO has received grants from the Scientific College of Physiotherapy (Wetenschappelijk College Fysiotherapie) of the Royal Dutch Association for Physiotherapy and from the Health Care Insurance Board (College voor zorgverzekeringen); MWvT has received grants from the Royal Dutch Physiotherapy Association.

Figures

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Fig 1 Flow of studies
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Fig 2 Risk of bias summary
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Fig 3 Multidisciplinary rehabilitation versus usual care in long term
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Fig 4 Multidisciplinary rehabilitation versus physical treatment in long term
See this image and copyright information in PMC

Comment in

References

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