Comment: The quality of evidence is downgraded by study limitations (unclear allocation concealment and selective reporting in half of the trials and in most of the studies no blinding of outcome assessors).
Clinical comment: Effects are of a modest magnitude and should be balanced against the time and resource requirements of MBR programs.
Clinical comment:
A Cochrane review cd000963 included 41 studies with a total of 6 858 subjects. Pooled estimates from 16 RCTs provided moderate to low quality evidence that multidisciplinary bio-psycho-social rehabilitation (MBR) is more effective than usual care in reducing pain and disability, with standardised mean differences (SMDs) in the long term of 0.21 (95% CI 0.04 to 0.37; 7 trials, n=821; translated to approximately 0.5 on a 0 to 10 numerical rating scale) and 0.23 (95% CI 0.06 to 0.4; 6 trials, n= 722; translated to approximately 1.4 points on a 0 to 24 Roland Morris Disability scale) respectively. There was moderate to low quality evidence of no difference on work outcomes (odds ratio (OR) at long term 1.04, 95% CI 0.73 to 1.47; 7 trials, n=1360). Pooled estimates from 19 RCTs provided moderate to low quality evidence that MBR was more effective than physical treatment for pain and disability with SMDs in the long term of 0.51 (95% CI -0.01 to 1.04; 9 trials, n=872; translated to approximately 1.2 on a 0 to 10 numerical rating scale) and 0.68 (95% CI 0.16 to 1.19; 10 trials, n=1169; translated to approximately 4 points on a 0 to 24 Roland Morris Disability scale) respectively. There was moderate to low quality evidence that people receiving a MBR intervention had approximately twice the odds of those receiving a purely physical treatment of being at work 12 months after the intervention (OR at long term 1.87, 95% CI 1.39 to 2.53; 8 trials, n=1006). There was insufficient evidence to assess whether MBR interventions were associated with more adverse events than usual care or physical interventions.
Primary/Secondary Keywords