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

Steven J Kamper, A T Apeldoorn, A Chiarotto, R J E M Smeets, R W J G Ostelo, J Guzman, M W van Tulder, Steven J Kamper, A T Apeldoorn, A Chiarotto, R J E M Smeets, R W J G Ostelo, J Guzman, M W van Tulder

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.

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.

© Kamper et al 2015.

Figures

https://www.ncbi.nlm.nih.gov/pmc/articles/instance/4794004/bin/kams021670.f1_default.jpg
Fig 1 Flow of studies
https://www.ncbi.nlm.nih.gov/pmc/articles/instance/4794004/bin/kams021670.f2_default.jpg
Fig 2 Risk of bias summary
https://www.ncbi.nlm.nih.gov/pmc/articles/instance/4794004/bin/kams021670.f3_default.jpg
Fig 3 Multidisciplinary rehabilitation versus usual care in long term
https://www.ncbi.nlm.nih.gov/pmc/articles/instance/4794004/bin/kams021670.f4_default.jpg
Fig 4 Multidisciplinary rehabilitation versus physical treatment in long term

References

    1. Vos T, Flaxman AD, Naghavi M, Lozano R, Michaud C, Ezzat M. Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012;380:2163-96.
    1. Henschke N, Maher CG, Refshauge KM, Herbert RD, Cumming RG, Bleasel J, et al. Prognosis in patients with recent onset low back pain in Australian primary care: inception cohort study. BMJ 2008;337:a171.
    1. Stanton TR, Latimer J, Maher CG, Hancock M. Definitions of recurrence of an episode of low back pain: a systematic review. Spine 2009;34:E316-22.
    1. Lambeek LC, van Tulder MW, Swinkels IC, Koppes LL, Anema J, van Mechelen W. The trend in total cost of back pain in the Netherlands in the period 2002 to 2007. Spine 2011;36:1050-8.
    1. Luo X, Pietrobon R, Sun SX, Liu GG, Hey L. Estimates and patterns of direct health care expenditures among individuals with back pain in the United States. Spine 2004;29:79-86.
    1. Furlan AD, Pennick V, Bombardier C, van Tulder MW. Updated method guidelines for systematic reviews in the Cochrane Back Review Group. Spine 2009;34:1929-41.
    1. Koes BW, van Tulder MW, Thomas S. Diagnosis and treatment of low back pain. BMJ 2006;332:1430-4.
    1. Waddell G. The back pain revolution. 2nd ed. Churchill Livingstone, 2004.
    1. Foster NE. Barriers and progress in the treatment of low back pain. BMC Med 2011;9:108.
    1. Machado LA, Kamper SJ, Herbert RD, Maher CG, McAuley JH. Analgesic effects of treatments for non-specific low back pain: a meta-analysis of placebo-controlled randomized trials. Rheumatol 2009;48:520-7.
    1. Guzman J, Esmail R, Karjalainen K, Malmivaara A, Irvin E, Bombardier C. Multidisciplinary rehabilitation for chronic low back pain: systematic review. BMJ 2001;322:1511-6.
    1. Guzman J, Esmail R, Karjalainen KA, Malmivaara A, Irvin E, Bombardier C. Multidisciplinary bio-psycho-social rehabilitation for chronic low-back pain. Cochrane Database Syst Rev 2002;1:CD00096.
    1. Higgins JPT, Green S, eds. Cochrane handbook for systematic reviews of interventions. Cochrane Collaboration, 2009.
    1. Cochrane Back Review Group. Criteria for judging risk of bias. 2011. .
    1. Van Tulder MW, Suttorp M, Morton S, Bouter L, Shekelle P. Empirical evidence of an association between internal validity and effect size in randomized controlled trials of low-back pain. Spine 2009;34:1685-92.
    1. Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck-Ytter Y. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ 2008;336:924-6.
    1. Guyatt GH, Oxman AD, Kunz R, Brozeka J, Alonso-Coellof P, Rind D, et al. GRADE guidelines 6. Rating the quality of evidence: imprecision. J Clin Epidemiol 2001;64:1283-93.
    1. Riley RD, Higgins JP, Deeks JJ. Interpretation of random-effects meta-analyses. BMJ 2011;342:d549.
    1. DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials 1986;7:177-88.
    1. Kamper SJ, Apeldoorn AT, Chiarotto A, Smeets RJ, Ostelo RW, Guzman J, et al. Multidisciplinary biopsychosocial rehabilitation for chronic low back pain. Cochrane Database Syst Rev 2014;9:CD000963.
    1. Abbasi M, Dehghani M, Keefe FJ, Jafari H, Behtash H, Shams J. Spouse-assisted training in pain coping skills and the outcome of multidisciplinary pain management for chronic low back pain treatment: a 1-year randomized controlled trial. Eur J Pain 2012;16:1033-43.
    1. Basler H, Jakle C, Kroner-Herwig B. Incorporation of cognitive behavioral treatment into the medical care of chronic low back patients: a controlled randomized study in German pain treatment centers. Patient Educat Counseling 1997;31:113-24.
    1. Bendix AF, Bendix T, Vaegter K, Lund C, Frolund L, Holm L. Multidisciplinary intensive treatment for chronic low back pain: a randomized, prospective study. Clev Clin J Med 1996;63:62-9.
    1. Lambeek LC, Bosmans JE, van Royen BJ, van Tulder MW, van Mechelen W, Anema JR. Effect of integrated care for sick listed patients with chronic low back pain: economic evaluation alongside a randomised controlled trial. BMJ 2010;341:d6414.
    1. Linton SJ, Boersma K, Jansson M, Svärd L, Botvalde M. The effects of cognitive-behavioral and physical therapy preventive interventions on pain-related sick leave: a randomized controlled trial. Clin J Pain 2005;21:109-19.
    1. Lukinmaa A. Low back pain as a biopsychosocial problem: a controlled clinical trial and a cost effectiveness analysis. Kansanelakelaitoksen Julkaisuja 1990;ML:1-90.
    1. Mitchell RI, Carmen GM. The functional restoration approach to the treatment of chronic pain in patients with soft tissue and back injuries. Spine 1994;19:633-42.
    1. Moix J, Canellas M, Osorio C, Bel X, Girvent F, Martos A. Efficacy of an interdisciplinary educational program in patients with chronic back pain. Dolor 2003;18:149-57.
    1. Morone G, Iosa M, Paolucci T, Fusco A, Alcuri R, Spadini E. Efficacy of perceptive rehabilitation in the treatment of chronic nonspecific low back pain through a new tool: a randomized clinical study. Clin Rehabil 2012;26:339-50.
    1. Morone G, Paolucci T, Alcuri MR, Vulpiani MC, Matano A, Bureca I. Quality of life improved by multidisciplinary back school program in patients with chronic non-specific low back pain: a single blind randomized controlled trial. EurJ Phys Rehabil Med 2011;47:533-41.
    1. Skouen JS, Grasdal AL, Haldorsen EM, Ursin H. Relative cost-effectiveness of extensive and light multidisciplinary treatment programs versus treatment as usual for patients with chronic low back pain on long-term sick leave: randomized controlled study. Spine 2002;27:901-9.
    1. Strand LI, Ljunggren AE, Haldorsen EM, Espehaug B. The impact of physical function and pain on work status at 1-year follow-up in patients with back pain. Spine 2001;26:800-8.
    1. Tavafian SS, Jamshidi AR, Mohammad K. Treatment of chronic low back pain: a randomized clinical trial comparing multidisciplinary group-based rehabilitation program and oral drug treatment with oral drug treatment alone. Clin J Pain 2011;27:811-8.
    1. Tavafian SS, Jamshidi AR, Montazeri A. A randomized study of back school in women with chronic low back pain quality of life at three, six, and twelve months follow-up. Spine 2008;33:1617-21.
    1. Vollenbroek-Hutten MM, Hermens HJ, Wever D, Gorter M, Rinket J, IJerman MJ. Differences in outcome of a multidisciplinary treatment between subgroups of chronic low back pain patients defined using two multiaxial assessment instruments: the Multidimensional Pain Inventory and lumbar dynamometry. Clin Rehabil 2004;18:566-79.
    1. Von Korff M, Balderson BH, Saunders K, Miglioretti DL, Lin EH, Berry S. A trial of an activating intervention for chronic back pain in primary care and physical therapy settings. Pain 2005;113:323-30.
    1. Bendix AE, Bendix T, Haestrup C, Busch E. A prospective, randomized 5-year follow-up study of functional restoration in chronic low back pain patients. Eur Spine J 1998;7:111-9.
    1. Lambeek LC, van Mechelen W, Knol DL, Loisel P, Anema JR. Randomised controlled trial of integrated care to reduce disability from chronic low back pain in working and private life. BMJ 2010;340:d750.
    1. Alaranta H, Rytökoski U, Rissanen A, Talo S, Rönnemaa T, Puukka P, et al. Intensive physical and psychosocial training program for patients with chronic low back pain: a controlled clinical trial. Spine 1994;19:1339-49.
    1. Bendix AF, Bendix T, Ostenfeld S, Busch E, Andersen A. Active treatment programs for patients with chronic low back pain: a prospective, randomized, observer blinded study. Eur Spine J 1995;4:149-52.
    1. Bendix T, Bendix A, Labriola M, Haestrup C, Ebbehoj N. Functional restoration versus outpatient physical training in chronic low back pain: a randomized comparative study. Spine 2000;25:2494-500.
    1. Coole C, Drummond A, Watson P. Individual work support for employed patients with low back pain: a randomized controlled pilot trial. Clin Rehabil 2013;27:40-50.
    1. Harkapaa K, Jarvikoski A, Mellin G, Hurri H. Pain, disability, compliance, and reported treatment benefits three months after treatment. Scand J Rehabil Med 1989;21:81-9.
    1. Henchoz Y, de Goumoens P, So AK, Paillex R. Functional multidisciplinary rehabilitation versus outpatient physiotherapy for non specific low back pain: randomized controlled trial. Swiss Med Weekly 2010;140:1-7.
    1. Jousset N, Fanello S, Bontoux L, Dubus V, Billabert C, Vielle B. Effects of functional restoration versus 3 hours per week physical therapy: a randomized controlled study. Spine 2004;29:487-94.
    1. Kaapa EH, Frantsi K, Sarna S, Malmivaara A. Multidisciplinary group rehabilitation versus individual physiotherapy for chronic nonspecific low back pain: a randomized trial. Spine 2006;31:371-6.
    1. Kool J, Bachmann S, Oesch P, Knuesel O, Ambergen T, de Bie R. Function-centered rehabilitation increases work days in patients with nonacute nonspecific low back pain: 1-year results from a randomized controlled trial. Arch Phys Med Rehabil 2007;88:1089-94.
    1. Mangels M, Schwarz S, Worringen U, Holme M, Rief W. Evaluation of a behavioral-medical inpatient rehabilitation treatment including booster sessions: a randomized controlled study. Clin J Pain 2009;25:356-64.
    1. Monticone M, Ferrante S, Rocca B, Baiardi P, Dal Farra F, Foti C. Effect of a long-lasting multidisciplinary program on disability and fear-avoidance behaviors in patients with chronic low back pain results of a randomized controlled trial. Clin J Pain 2013;29:929-38.
    1. Nicholas MK, Wilson PH, Goyen J. Operant-behavioural and cognitive behavioural treatment for chronic low back pain. Behav Research Ther 1991;29:225-38.
    1. Nicholas MK, Wilson PH, Goyen J. Comparison of cognitive behavioral group treatment and an alternative non-psychological treatment for chronic low back pain. Pain 1992;48:339-47.
    1. Roche G, Ponthieux A, Parot-Shinkel E, Jousset N, Bontoux L, Dubus V. Comparison of a functional restoration program with active individual physical therapy for patients with chronic low back pain: a randomized controlled trial. Arch Phys Med Rehabil 2007;88:1229-35.
    1. Roche-Leboucher G, Petit-Lemanach A, Bontoux L, Dubus-Bausiere V, Parot-Shinkel E, Fanello S. Multidisciplinary intensive functional restoration versus outpatient active physiotherapy in chronic low back pain: a randomized controlled trial. Spine 2011;36:2235-42.
    1. Schweikert B, Jacobi E, Seitz R, Cziske R, Ehlert A, Knab J. Effectiveness and cost-effectiveness of adding a cognitive behavioral treatment to the rehabilitation of chronic low back pain. J Rheumatol 2006;33:2519-26.
    1. Smeets RJ, Vlaeyen JW, Hidding A, Kester AD, van der Heijden GJ, Knottnerus JA. Chronic low back pain: physical training, graded activity with problem solving training, or both? The one-year post-treatment results of a randomized controlled trial. Pain 2008;134:263-76.
    1. Smeets RJ, Vlaeyen JW, Hidding A, Kester AD, van der Heijden GJ, van Geel AC, et al. Active rehabilitation for chronic low back pain: cognitive-behavioral, physical, or both? First direct post-treatment results from a randomized controlled trial. BMC Musculoskel Disord 2006;7:5.
    1. Streibelt M, Thren K, Muller-Fahrnow W. Effects of FCE-based multidisciplinary rehabilitation in patients with chronic musculoskeletal disorders—results of a randomized controlled trial. Physikalische Medizin Rehabilitationsmedizin Kurortmedizin 2009;19:34-41.
    1. Turner JA, Clancy S, McQuade KJ, Cardenas DD. Effectiveness of behavioral therapy for chronic low back pain: a component analysis. J Consult Clin Psychol 1990;58:573-9.
    1. Kool JP, Oesch PR, Bachmann S, Knuesel O, Dierkes JG, Russo M, et al. Increasing days at work using function-centered rehabilitation in nonacute nonspecific low back pain: a randomized controlled trial. Arch Phys Med Rehabil 2005;86:857-64.
    1. Fairbank J, Frost H, Wilson-MacDonald J, Yu LM, Barker K, Collins R. Randomised controlled trial to compare surgical stabilisation of the lumbar spine with an intensive rehabilitation programme for patients with chronic low back pain: the MRC spine stabilisation trial. BMJ 2005;330:1233-8.
    1. Hellum C, Johnsen LG, Storheim K, Nygaard OP, Brox JI, Rossvoll I, et al. Surgery with disc prosthesis versus rehabilitation in patients with low back pain and degenerative disc: two year follow-up of randomised study. BMJ 2011;342:d2786.
    1. Jackel WH, Cziske R, Gerdes N, Jacobi E. Assessment of the effectiveness of inpatient rehabilitation measures in patients with chronic low back pain: a prospective, randomized, controlled study. Rehabilitation (Stuttg) 1990;29:219-33.
    1. Kole-Snijders AM, Vlaeyen JW, Goossens ME, Rutten-Van Molken MP, Heuts PH, van Breukelen G, et al. Results of a randomized clinical trial. J Consult Clin Psychol 1999;67:931-44.
    1. Leeuw M, Goossens ME, van Breukelen GJ, de Jong JR, Heuts PH, Smeets RJ, et al. Exposure in vivo versus operant graded activity in chronic low back pain patients: results of a randomized controlled trial. Pain 2008;138:192-207.
    1. Meng K, Seekatz B, Roband H, Worringen U, Vogel H, Faller H. Intermediate and long-term effects of a standardized back school for inpatient orthopedic rehabilitation on illness knowledge and self-management behaviors: a randomized controlled trial. Clin J Pain 2011;27:248-57.
    1. Van den Hout JH, Vlaeyen JW, Heuts PH, Zijlema JH, Wijnen JA. Secondary prevention of work-related disability in nonspecific low back pain: does problem-solving therapy help? A randomized clinical trial. Clin J Pain 2003;19:87-92.
    1. Costa Lda C, Maher CG, McAuley JH, Hancock MJ, Herbert RD, Refshauge KM, et al. Prognosis for patients with chronic low back pain: inception cohort study. BMJ 2009;339:b3829.
    1. Chou R, Baisden J, Carragee EJ, Resnick DK, Shaffer WO, Loeser JD. Surgery for low back pain: a review of the evidence for an American Pain Society clinical practice guideline. Spine 2009;34:1094-109.
    1. Waterschoot FP, Dijkstra PU, Hollak N, de Vries HJ, Geertzen JH, Reneman MF. Dose or content? Effectiveness of pain rehabilitation programs for patients with chronic low back pain: a systematic review. Pain 2014;155:179-89.
    1. Ravenek MJ, Hughes ID, Ivanovich N, Tyrer K, Desrochers C, Klinger L, et al. A systematic review of multidisciplinary outcomes in the management of chronic low back pain. Work 2010;35:349-67.
    1. Van Geen JW, Edelaar MJ, Janssen M, van Eijk JT. The long-term effect of multidisciplinary back training: a systematic review. Spine 2007;32:249-55.
    1. Norlund A, Ropponen A, Alexanderson K. Multidisciplinary interventions: review of studies of return to work after rehabilitation for low back pain. J Rehabil Med 2009;41:115-21.
    1. Dagenais S, Tricco AC, Haldeman S. Synthesis of recommendations for the assessment and management of low back pain from recent clinical practice guidelines. Spine J 2010;10:514-29.
    1. Koes BW, van Tulder MW, Lin CW, Macedo LG, McAuley JH, Maher CG. An updated overview of clinical guidelines for the management of non-specific low back pain in primary care. Eur Spine J 2010;19:2075-94.
    1. Hill JC, Whitehurst DG, Lewis M, Bryan S, Dunn KM, Foster NE, et al. Comparison of stratified primary care management for low back pain with current best practice (STarT Back): a randomised controlled trial. Lancet 2011;378:1560-71.
    1. Hancock M, Herbert RD, Maher CG. A guide to interpretation of studies investigating subgroups of responders to physical therapy interventions. Phys Ther 2009;89:698-704.
    1. Kamper SJ, Maher CG, Hancock MJ, Koes BW, Croft P, Hay EM. Treatment-based subgroups of low back pain: a guide to appraisal of research studies and a summary of current evidence. Best Pract Res Clin Rheumatol 2010;24:181-9.
    1. Mansell G, Kamper SJ, Kent P. Why and how back pain interventions work: what can we do to find out? Best Pract Res Clin Rheumatol 2013;27:685-97.
    1. Smeets RJ, Vlaeyen JW, Kester AD, Knottnerus JA. Reduction of pain catastrophizing mediates the outcome of both physical and cognitive-behavioral treatment in chronic low back pain. J Pain 2006;7:261-71.

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