title: Multidisciplinary biopsychosocial rehabilitation for neck and shoulder pain among working age adults.
abstract: BACKGROUND
  Multidisciplinary biopsychosocial rehabilitation programs for neck and shoulder pain require substantial staff and financial resources. Despite questionable scientific evidence of their effectiveness, they are widely used. Neck and shoulder complaints are common among working age adults and they are often associated with physical work load and stress. Pain in the neck and shoulder area cause biopsychosocial difficulties for the patient especially if disability due to pain is prolonged. To help patients with biopsychosocial problems or to prevent their development, multidisciplinary biopsychosocial programs are applied on rehabilitation for neck and shoulder pain patients. Nevertheless multidisciplinary treatment programmes are often laborious and rather long processes and require good collaboration between the patient, the rehabilitation team and the work place.
  
  
  OBJECTIVE
  The objective of this systematic review was to determine the effectiveness of multidisciplinary biopsychosocial rehabilitation for neck and shoulder pain among working age adults.
  
  
  METHODS
  The reviewed studies for this structured Cochrane review were identified from electronic bibliographic databases, the Science Citation Index, reference checking and consulting experts in the rehabilitation field. The original search was planned and performed for more broad area of musculoskeletal disorders. Trials on neck and shoulder pain were separated afterwards.
  
  
  METHODS
  From all references found in our original search we selected randomized controlled trials (RCTs) and non-randomized controlled clinical trials (CCTs). Trials had to assess the effectiveness of biopsychosocial rehabilitation for patients suffering from neck and shoulder pain among working age adults. The rehabilitation program was required to be multidisciplinary, i.e.; it had to consist of a physician's consultation plus either a psychological, social or vocational intervention, or a combination of these.
  
  
  METHODS
  Four blinded reviewers selected the randomized controlled trials and controlled trials that met the specified inclusion criteria. Two experts in the field of rehabilitation evaluated the clinical relevance and applicability of the findings of the selected studies to actual clinical use. Two other blinded reviewers extracted the data and assessed the main results and the methodological quality of the studies using standardized forms. Finally, a qualitative analysis was performed to evaluate the level of scientific evidence for the effectiveness of multidisciplinary biopsychosocial rehabilitation.
  
  
  RESULTS
  After screening 1808 abstracts, and the references of 65 reviews, we found only 2 relevant studies that satisfied our criteria. One of these was considered methodologically low quality randomized controlled trial and the other one was a methodologically low quality controlled clinical trial. The clinical relevance of included studies was satisfactory. The level of scientific evidence for the effectiveness of multidisciplinary biopsychosocial rehabilitation was limited for neck and shoulder pain.
  
  
  CONCLUSIONS
  We conclude that there appears to be little scientific evidence for the effectiveness of multidisciplinary biopsychosocial rehabilitation compared with other rehabilitation facilities on neck and shoulder pain. Multidisciplinary rehabilitation is a commonly used intervention for chronic neck and shoulder complaints, therefore we see an urgent need for high quality trials in this field.
authors.affiliation: Finnish Institute of Occupational Health, Topeliuksenkatu 41 aA, Helsinki, Finland. Kaija.Karjalainen@occuphealth.fi
authors.forename: K
authors.initials: K
authors.lastname: Karjalainen
authors.forename: A
authors.initials: A
authors.lastname: Malmivaara
authors.forename: M
authors.initials: M
authors.lastname: van Tulder
authors.forename: R
authors.initials: R
authors.lastname: Roine
authors.forename: M
authors.initials: M
authors.lastname: Jauhiainen
authors.forename: H
authors.initials: H
authors.lastname: Hurri
authors.forename: B
authors.initials: B
authors.lastname: Koes
mesh_terms: D000328:Adult; D002986:Clinical Trials as Topic; D003131:Combined Modality Therapy; D006801:Humans; D008875:Middle Aged; D019547:Neck Pain / Q000534:rehabilitation*; D018710:Pain Clinics; D020069:Shoulder Pain / Q000534:rehabilitation*