BMJ 2001;322:1511-1516 ( 23 June )

Papers

Multidisciplinary rehabilitation for chronic low back pain: systematic review

Jaime Guzmán, research fellow, ^a Rosmin Esmail, Cochrane Collaboration coordinator, ^a Kaija Karjalainen, research fellow, ^b Antti Malmivaara, assistant chief physician, ^b Emma Irvin, manager, information systems, ^a Claire Bombardier, senior scientist. ^a

^a Institute for Work and Health, Toronto, Canada M4W 1E6, ^b Finnish Institute of Occupational Health, Helsinki, Finland 00250

Correspondence to: J Guzmán, University of Manitoba Faculty of Medicine, S112-750 Bannatyne Avenue, Winnipeg MB, Canada R3E 0W3

Objective: To assess the effect of multidisciplinary biopsychosocial rehabilitation on clinically relevant outcomes in patients with chronic low back pain.
Design: Systematic literature review of randomised controlled trials.
Participants: A total of 1964 patients with disabling low back pain for more than three months.
Main outcome measures: Pain, function, employment, quality of life, and global assessments.
Results: Ten trials reported on a total of 12 randomised comparisons of multidisciplinary treatment and a control condition. There was strong evidence that intensive multidisciplinary biopsychosocial rehabilitation with functional restoration improves function when compared with inpatient or outpatient non-multidisciplinary treatments. There was moderate evidence that intensive multidisciplinary biopsychosocial rehabilitation with functional restoration reduces pain when compared with outpatient non-multidisciplinary rehabilitation or usual care. There was contradictory evidence regarding vocational outcomes of intensive multidisciplinary biopsychosocial intervention. Some trials reported improvements in work readiness, but others showed no significant reduction in sickness leaves. Less intensive outpatient psychophysical treatments did not improve pain, function, or vocational outcomes when compared with non-multidisciplinary outpatient therapy or usual care. Few trials reported effects on quality of life or global assessments.
Conclusions: The reviewed trials provide evidence that intensive multidisciplinary biopsychosocial rehabilitation with functional restoration reduces pain and improves function in patients with chronic low back pain. Less intensive interventions did not show improvements in clinically relevant outcomes.

What is already known on this topic Disabling chronic pain is regarded as the result of interrelating physical, psychological, and social or occupational factors requiring multidisciplinary intervention Two previous systematic reviews of multidisciplinary rehabilitation for chronic pain were open to bias and did not include any of the randomised controlled trials now available What this study adds Intensive, daily biopsychosocial rehabilitation with a functional restoration approach improves pain and function in chronic low back pain Less intensive interventions did not show improvements in clinically relevant outcomes It is unclear whether the improvements are worth the cost of these intensive treatments

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Rapid Responses:

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William Notcutt
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