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.
METHODS
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.


BACKGROUND
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.
Finnish Institute of Occupational Health, Helsinki, Finland. kaija.karjalainen@occuphealth.fi
K
K
Karjalainen
A
A
Malmivaara
M
M
van Tulder
R
R
Roine
M
M
Jauhiainen
H
H
Hurri
B
B
Koes
D006801:Humans; D017116:Low Back Pain / Q000523:psychology* / Q000534:rehabilitation*; D018710:Pain Clinics; D016032:Randomized Controlled Trials as Topic; D012944:Social Support; D016896:Treatment Outcome