title: Multidisciplinary biopsychosocial rehabilitation for neck and shoulder pain among working age adults: a systematic review within the framework of the Cochrane Collaboration Back Review Group.
abstract: METHODS
  A systematic review of randomized controlled trials.
  
  
  OBJECTIVE
  To evaluate the effectiveness of multidisciplinary biopsychosocial rehabilitation for neck and shoulder pain among working age adults.
  
  
  BACKGROUND
  Multidisciplinary biopsychosocial rehabilitation programs for neck and shoulder pain require substantial staff and financial resources. They are widely used, despite questionable evidence of their effectiveness.
  
  
  METHODS
  The reviewed randomized controlled and controlled trials appraising the effectiveness of biopsychosocial rehabilitation for working age patients with neck and shoulder pain were identified by searching electronic bibliographic databases, checking references, and consulting experts in the rehabilitation field. Four blinded reviewers selected the trials. Two specialists on rehabilitation evaluated the clinical relevance. Two other blinded reviewers extracted the data and assessed the main results and the methodologic quality of the studies. A qualitative analysis was performed to evaluate the level of scientific evidence.
  
  
  RESULTS
  After 1808 abstracts and the references of 65 reviews were screened, only two relevant studies were found that satisfied the criteria. One of these was considered a methodologically low-quality randomized controlled trial, and the other 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 for neck and shoulder pain was limited.
  
  
  CONCLUSIONS
  There appears to be little scientific evidence for the effectiveness on neck and shoulder pain of multidisciplinary biopsychosocial rehabilitation compared with other rehabilitation methods. There is an urgent need for high-quality trials in this field.
authors.affiliation: Finnish Institute of Occupational Health, Helsinki, Finland. kaija.karalainen@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; D000367:Age Factors; D002986:Clinical Trials as Topic; D006801:Humans; D009140:Musculoskeletal Diseases / Q000523:psychology / Q000534:rehabilitation*; D019547:Neck Pain / Q000523:psychology / Q000534:rehabilitation*; D018710:Pain Clinics; D011584:Psychology; D015203:Reproducibility of Results; D020069:Shoulder Pain / Q000523:psychology / Q000534:rehabilitation*; D016896:Treatment Outcome