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Multidisciplinary Biopsychosocial Rehabilitation for Subacute Low Back Pain in Working-Age Adults: A Systematic Review Within the Framework of the Cochrane Collaboration Back Review Group

Karjalainen, Kaija, MD*; Malmivaara, Antti, MD, PhD*; van Tulder, Maurits, PhD; Roine, Risto, MD, PhD; Jauhiainen, Merja, MSc*; Hurri, Heikki, MD, PhD§; Koes, Bart, PhD‖‖

Cochrane Collaboration Review

Study Design.  A systematic review of randomized controlled trials was performed.

Objective. To evaluate the effectiveness of multidisciplinary biopsychosocial rehabilitation for subacute low back pain among working-age adults.

Summary of Background Data.  Multidisciplinary biopsychosocial rehabilitation programs are widely applied for patients with chronic low back pain. The multidisciplinary biopsychosocial approach for prolonged low back pain could be considered to prevent chronicity. Work site visits and a close relationship with occupational health care might produce results in terms of patients working ability.

Methods. Reviewed randomized controlled trials as well as controlled trials were identified from electronic bibliographic databases, reference checking, and consultation with experts in the rehabilitation field. Four blinded reviewers selected the trials. Two rehabilitation specialists evaluated the clinical relevance. Two other blinded reviewers extracted the data and assessed the main results along with the methodologic quality of the studies. A qualitative analysis was performed to evaluate the level evidence.

Results. Of 1808 references, only 2 relevant studies were included. Both were considered to be methodologically low-quality randomized controlled trials. The clinical relevance of the studies was sufficient. The level of scientific evidence was moderate, showing that multidisciplinary rehabilitation involving work site visit or more comprehensive occupational health care intervention helps patients return to work faster, makes sick leaves less, and alleviates subjective disability.

Conclusions. There is moderate evidence showing that multidisciplinary rehabilitation for subacute low back pain is effective, and that work site visit increases the effectiveness, but because the analyzed studies had some methodologic shortcomings, an obvious need still exists for high-quality trials in this field.

From the *Finnish Institute of Occupational Health, Helsinki, Finland, the †Vrije Universiteit, EMGO Institute, Amsterdam, The Netherlands, the ‡Finnish Office for Health Care Technology Assessment, Helsinki, Finland, the §ORTON Rehabilitation Centre, Helsinki, Finland, and the ‖‖Erasmus Universiteit Rotterdam, Department of General Practice, Rotterdam, The Netherlands.

Supported by a grant from the Finnish Office for Health Care Technology Assessment.

Acknowledgment date: xx

First revision date: xx

Acceptance date: xx

Address reprint requests to

Kaija Karjalainen, MD

2 Redlands Place

Wokingham

Berkshire

RG41 4ED

UK

E-mail: kaija.karjalainen@occuphealth.fi

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© 2001 Lippincott Williams & Wilkins, Inc.