Multidisciplinary Biopsychosocial Rehabilitation Improves Outcomes for Patients With Chronic Low Back Pain
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Frances Nanadiego
Kamper SJ, Apeldoorn AT, Chiarotto A, et al. Multidisciplinary biopsychosocial rehabilitation for chronic low back pain: Cochrane systematic review and meta-analysis. BMJ. 2015;350:h444. doi:10.1136/bmj.h444.
This systematic review and meta-analysis of randomized controlled trials (RCTs) investigated the outcomes of multidisciplinary biopsychosocial rehabilitation for chronic low back pain compared with those of usual care, physical treatment, surgery, and a waitlist. A total of 41 studies were included, in which more than 75% of the participants had low back pain and the diagnosis of disk degeneration or bulging disks, facet joint dysfunction, or sacroiliac joint pain. The sample sizes ranged from 20 to 542 people, with a combined total of 6858 participants. The average age of the participants was between 40 and 45 years. Articles were excluded if the chronic low back pain resulted from any form of inflammatory articular disease.
Multidisciplinary rehabilitation (MR) intervention involved a physical component alongside a psychological or social- or work-targeted component. Usual care varied according to physician. Physical treatments included electrotherapeutic modalities; aerobic, stretching, and strengthening exercises; and manual therapies, but not osteopathic manipulation. The primary measured outcomes were pain, disability, and work absenteeism.
Sixteen RCTs measured the effects of MR vs usual care. Moderate-quality evidence showed that MR was more effective than usual care for long-term pain (7 trials, n=821) and disability (6 trials, n=722) but that MR had no effect above that of usual care in regard to work absenteeism (7 trials, n=1360).
Nineteen RCTs compared the outcomes of MR vs physical treatment. Low-quality evidence demonstrated that MR was more effective than physical treatment for long-term pain and disability (10 trials, n=1169). Moderate-quality evidence demonstrated that MR was more effective than physical treatment for work absenteeism (8 trials, n=1006). Low-quality evidence found that MR was not significantly different from surgical procedures in improving pain, disability, or work absenteeism (2 trials, n=423); however, more adverse events were reported in the surgical studies. Three trials provided low-quality evidence that MR was more effective than control (waitlist) in reducing pain and disability.
This review provides moderate- to low-quality evidence demonstrating that MR is more effective than usual care and physical treatment in patients with chronic low back pain. Although osteopathic manipulation studies were not considered, the results are of interest to osteopathic physicians because of the demonstration of the effectiveness of a biopsychosocial approach, which is a cornerstone of osteopathic care.
© 2016 American Osteopathic Association
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
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- BOOK REVIEWS
- A View From the Inside: A Collection of Medically Oriented Short Stories
- EDITORIAL
- ENGAGE Initiative: Showcasing Osteopathic Scholarly Activity
- Building Primary Care Research Capacity in a College of Osteopathic Medicine
- Correction
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- LETTERS TO THE EDITOR
- Interstate Medical Licensure Compact: Pernicious Myths and Inescapable Facts
- AOA COMMUNICATION
- Proposed Amendments to the AOA Constitution, Bylaws, and Code of Ethics
- ORIGINAL CONTRIBUTION
- Effectiveness of Home Blood Pressure Monitoring Among Low-Income Adults in Rural Appalachia
- CLINICAL REVIEW
- Is Meat Killing Us?
- MEDICAL EDUCATION
- Premedical Students’ Attitudes Toward Primary Care Medicine
- SPECIAL COMMUNICATION
- Growing Research Among Osteopathic Residents and Medical Students: A Consortium-Based Research Education Continuum Model
- CASE REPORT
- Intact Cornual Ectopic Pregnancy and Dermoid Cyst With Intraoperative Rupture
- Transient Ischemic Attack After Foam Sclerotherapy in a Woman With a Patent Foramen Ovale
- THE SOMATIC CONNECTION
- Eye Contact, Appetite, and Vomiting Improved in Children With Autism Spectrum Disorder After Visceral Osteopathic Technique
- Postural Balance and Gait Improved With an Osteopathic Intervention in a Special Needs Population
- Significant Benefit Shown After Lumbar Disk Surgery Rehabilitation by Inclusion of Osteopathic Intervention
- Spinal Mobilization Has Peripheral Vasodilation Effects
- Multidisciplinary Biopsychosocial Rehabilitation Improves Outcomes for Patients With Chronic Low Back Pain
- Manual Therapy for Hamstring Hypertonicity Improves Temporomandibular Dysfunction in Athletes
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