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Review
. 2001 Jun 23;322(7301):1511-6.
doi: 10.1136/bmj.322.7301.1511.

Multidisciplinary rehabilitation for chronic low back pain: systematic review

J Guzmán  1 , R Esmail, K Karjalainen, A Malmivaara, E Irvin, C Bombardier
Affiliations
Review

Multidisciplinary rehabilitation for chronic low back pain: systematic review

J Guzmán et al. BMJ. .

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.

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Figures

Figure
Figure
Treatment effect sizes for 12 randomised comparisons of multidisciplinary biopsychosocial rehabilitation and a control condition. Bars represent standardised mean differences and 95% confidence intervals for comparison of intervention and control groups, except for employment status where bars represent relative risks. Treatment effect sizes entirely to the left of the vertical line indicate statistically significant differences in favour of the intervention
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