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Multidisciplinary rehabilitation for chronic low back pain: systematic review

BMJ 2001; 322 doi: https://doi.org/10.1136/bmj.322.7301.1511 (Published 23 June 2001) Cite this as: BMJ 2001;322:1511
  1. Jaime Guzmán, research fellowa,
  2. Rosmin Esmail, Cochrane Collaboration coordinatora,
  3. Kaija Karjalainen, research fellowb,
  4. Antti Malmivaara, assistant chief physicianb,
  5. Emma Irvin, manager, information systemsa,
  6. Claire Bombardier, senior scientista
  1. a Institute for Work and Health, Toronto, Canada M4W 1E6
  2. b Finnish Institute of Occupational Health, Helsinki, Finland 00250
  1. Correspondence to: J Guzmán, University of Manitoba Faculty of Medicine, S112-750 Bannatyne Avenue, Winnipeg MB, Canada R3E 0W3
  • Accepted 6 April 2001

Abstract

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

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

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

Footnotes

  • Funding JG received a research fellowship from the Institute for Work and Health, an independent, not-for-profit research organisation that receives support from the Ontario Workplace Safety and Insurance Board. KK's work was supported by a fellowship from the Finnish Office for Health Care Technology Assessment. RE is currently with the Calgary Regional Health Authority, Calgary, Canada.

  • Competing interests None declared.

  • Graphic Tables detailing the content of multidisciplinary rehabilitation programmes and the crude outcomes of the trials are on the BMJ's website

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