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Psychological interventions in the rehabilitation of patients with chronic low back pain: evidence and recommendations from systematic reviews and guidelines

Reese, Christina; Mittag, Oskar

International Journal of Rehabilitation Research:
doi: 10.1097/MRR.0b013e32835acfec
Review articles
Abstract

The purpose of the article is to summarize evidence and recommendations for psychological interventions in the rehabilitation of patients with chronic low back pain. We carried out a systematic literature search in several databases and on the websites of professional associations to identify relevant reviews and guidelines. In addition to the electronic search, a handsearch was carried out. Eligible publications were selected. We extracted and summarized both evidence for psychological interventions and recommendations on psychological diagnostics and interventions. Six systematic reviews and 14 guidelines were included. We collected recommendations and partially restricted evidence on the following psychological interventions: behavioural therapy, fear-avoidance training, stress management, relaxation therapy, patient education and back school. Most available evidence for psychological interventions in the rehabilitation of patients with chronic low back pain is of moderate to low quality. In addition, some of the older evidence is inapplicable to modern interventions using a biopsychosocial approach. Thus, high quality and current evidence is needed. The summary of guidelines shows that multimodal, multidisciplinary programmes including psychological interventions have become standard in the rehabilitation of patients with chronic low back pain. In most guidelines, however, there are no recommendations on which (psychological) intervention should be considered for which specific problem (problem–treatment pairs). Suggestions for future research and future guidelines are made.

Author Information

Department of Quality Management and Social Medicine, University Medical Center Freiburg, Freiburg, Germany

Correspondence to Christina Reese, MSc, Department of Quality Management and Social Medicine, University Medical Center Freiburg, Engelbergerstr. 21, D-79106 Freiburg, Germany Tel: +49 761 270 18510; fax: +49 761 270 73310; e-mail: christina.reese@uniklinik-freiburg.de

Received June 13, 2012

Accepted September 10, 2012

© 2013 Lippincott Williams & Wilkins, Inc.