Letters

Rehabilitation for chronic low back pain

BMJ 2001; 323 doi: https://doi.org/10.1136/bmj.323.7323.1251 (Published 24 November 2001) Cite this as: BMJ 2001;323:1251

Review was of little help in selecting treatment

  1. Cathy Price, consultant in pain management (cathyprice@freeuk.com),
  2. C Williams Amanda C de, senior lecturer in clinical health psychology,
  3. Chris J Main, professor in behavioural medicine
  1. Southampton University Hospitals NHS Trust, Southampton SO14 0YG
  2. Guy's, King's and St Thomas's Medical School and INPUT Pain Management Programme, St Thomas's Hospital, London SE11 6SP
  3. Salford Behavioural Medicine Research Unit, Hope Hospital, Salford M6 8HD
  4. Institute for Work and Health, Toronto, Canada M4W 1E6
  5. Finnish Institute of Occupational Health, Helsinki, Finland 00250
  6. Institute for Work and Health, Toronto, Canada M4W 1E6

    EDITOR—We have misgivings about the conclusions drawn by Guzmán et al on multidisciplinary rehabilitation for chronic low back pain.1 Low back pain problems are as heterogeneous as the wider category of chronic pain, and in disregarding systematic reviews and meta-analyses of multidisciplinary rehabilitation in chronic pain Guzmán et al have missed a large body of relevant evidence, including trials of cost effectiveness. 2 3

    Standard quality criteria used for randomised controlled trials cannot be applied in an unmodified form to psychological treatments, which constitute important components of multidisciplinary rehabilitation. The impossibility of blinding patients and therapists need not lower standards. Several trials reviewed employed recognised methods for establishing treatment equivalence: patient rating of treatment credibility or expectations; manualised treatments; blind rating by experts of treatment excerpts; and close supervision of therapists. It is disappointing to see the Cochrane Back Review Group continuing to apply inappropriate criteria and thereby misjudging methodological quality of trials.

    Variability in outcome arises from heterogeneity …

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