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 used for rehabilitation for patients with neck and shoulder pain. 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 review were electronically identified from MEDLINE, EMBASE, PsycLIT, CENTRAL, Medic, 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. The literature search was updated in November 2002 by electronically searching MEDLINE and EMBASE.
  
  
  METHODS
  From all references identified 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 working age adults suffering from neck and shoulder pain. 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 reviewers blinded to journal and author selected the 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 for actual clinical use. Two other reviewers blinded to journal and author 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 two relevant studies that satisfied our criteria. No more studies were found for this update. One of the studies was considered to be a methodologically low quality RCT and the other one was a methodologically low quality CCT. The clinical relevance of included studies was satisfactory. There was limited scientific evidence for the effectiveness of multidisciplinary biopsychosocial rehabilitation 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 for 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: Occupational Medicine, 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; D003131:Combined Modality Therapy; D006801:Humans; D008875:Middle Aged; D019547:Neck Pain / Q000523:psychology / Q000534:rehabilitation*; D018710:Pain Clinics; D016032:Randomized Controlled Trials as Topic; D020069:Shoulder Pain / Q000523:psychology / Q000534:rehabilitation*