title: Multidisciplinary biopsychosocial rehabilitation for chronic low back pain: Cochrane systematic review and meta-analysis.
abstract: OBJECTIVE
  To assess the long term effects of multidisciplinary biopsychosocial rehabilitation for patients with chronic low back pain.
  
  
  METHODS
  Systematic review and random effects meta-analysis of randomised controlled trials.
  
  
  METHODS
  Electronic searches of Cochrane Back Review Group Trials Register, CENTRAL, Medline, Embase, PsycINFO, and CINAHL databases up to February 2014, supplemented by hand searching of reference lists and forward citation tracking of included trials.
  
  
  METHODS
  Trials published in full; participants with low back pain for more than three months; multidisciplinary rehabilitation involved a physical component and one or both of a psychological component or a social or work targeted component; multidisciplinary rehabilitation was delivered by healthcare professionals from at least two different professional backgrounds; multidisciplinary rehabilitation was compared with a non- multidisciplinary intervention.
  
  
  RESULTS
  Forty one trials included a total of 6858 participants with a mean duration of pain of more than one year who often had failed previous treatment. Sixteen trials provided moderate quality evidence that multidisciplinary rehabilitation decreased pain (standardised mean difference 0.21, 95% confidence interval 0.04 to 0.37; equivalent to 0.5 points in a 10 point pain scale) and disability (0.23, 0.06 to 0.40; equivalent to 1.5 points in a 24 point Roland-Morris index) compared with usual care. Nineteen trials provided low quality evidence that multidisciplinary rehabilitation decreased pain (standardised mean difference 0.51, -0.01 to 1.04) and disability (0.68, 0.16 to 1.19) compared with physical treatments, but significant statistical heterogeneity across trials was present. Eight trials provided moderate quality evidence that multidisciplinary rehabilitation improves the odds of being at work one year after intervention (odds ratio 1.87, 95% confidence interval 1.39 to 2.53) compared with physical treatments. Seven trials provided moderate quality evidence that multidisciplinary rehabilitation does not improve the odds of being at work (odds ratio 1.04, 0.73 to 1.47) compared with usual care. Two trials that compared multidisciplinary rehabilitation with surgery found little difference in outcomes and an increased risk of adverse events with surgery.
  
  
  CONCLUSIONS
  Multidisciplinary biopsychosocial rehabilitation interventions were more effective than usual care (moderate quality evidence) and physical treatments (low quality evidence) in decreasing pain and disability in people with chronic low back pain. For work outcomes, multidisciplinary rehabilitation seems to be more effective than physical treatment but not more effective than usual care.
authors.affiliation: Musculoskeletal Division, George Institute, University of Sydney, Sydney 2050, NSW, Australia Department of Epidemiology and Biostatistics and the EMGO+ Institute, VU University Medical Centre, Amsterdam 1081BT, Netherlands skamper@george.org.au.
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Kamper
authors.affiliation: Department of Epidemiology and Biostatistics and the EMGO+ Institute, VU University Medical Centre, Amsterdam 1081BT, Netherlands.
authors.forename: A T
authors.initials: AT
authors.lastname: Apeldoorn
authors.affiliation: Department of Epidemiology and Biostatistics and the EMGO+ Institute, VU University Medical Centre, Amsterdam 1081BT, Netherlands.
authors.forename: A
authors.initials: A
authors.lastname: Chiarotto
authors.affiliation: Rehabilitation Medicine Department, Maastricht University Medical Centre, Maastricht 6200MD, Netherlands.
authors.forename: R J E M
authors.initials: RJ
authors.lastname: Smeets
authors.affiliation: Department of Epidemiology and Biostatistics and the EMGO+ Institute, VU University Medical Centre, Amsterdam 1081BT, Netherlands Department of Health Sciences, Faculty of Earth and Life Sciences, VU University, Amsterdam 1081HV, Netherlands.
authors.forename: R W J G
authors.initials: RW
authors.lastname: Ostelo
authors.affiliation: University of British Columbia, Vancouver, Canada V6T 1Z3.
authors.forename: J
authors.initials: J
authors.lastname: Guzman
authors.affiliation: Department of Health Sciences, Faculty of Earth and Life Sciences, VU University, Amsterdam 1081HV, Netherlands.
authors.forename: M W
authors.initials: MW
authors.lastname: van Tulder
mesh_terms: D001416:Back Pain / Q000523:psychology / Q000534:rehabilitation*; D002908:Chronic Disease; D006801:Humans; D009788:Occupational Therapy / Q000379:methods; D011613:Psychotherapy; D016032:Randomized Controlled Trials as Topic; D012944:Social Support