• J Guzmán, R Esmail, K Karjalainen, A Malmivaara, E Irvin, and C Bombardier.
• Institute for Work and Health, Toronto, Canada M4W 1E6.
• BMJ. 2001 Jun 23;322(7301):1511-6.

ObjectiveTo assess the effect of multidisciplinary biopsychosocial rehabilitation on clinically relevant outcomes in patients with chronic low back pain.DesignSystematic literature review of randomised controlled trials.ParticipantsA total of 1964 patients with disabling low back pain for more than three months.Main Outcome MeasuresPain, function, employment, quality of life, and global assessments.ResultsTen trials reported on a total of 12 randomised comparisons of multidisciplinary treatment and a control condition. There was strong evidence that intensive multidisciplinary biopsychosocial rehabilitation with functional restoration improves function when compared with inpatient or outpatient non-multidisciplinary treatments. There was moderate evidence that intensive multidisciplinary biopsychosocial rehabilitation with functional restoration reduces pain when compared with outpatient non-multidisciplinary rehabilitation or usual care. There was contradictory evidence regarding vocational outcomes of intensive multidisciplinary biopsychosocial intervention. Some trials reported improvements in work readiness, but others showed no significant reduction in sickness leaves. Less intensive outpatient psychophysical treatments did not improve pain, function, or vocational outcomes when compared with non-multidisciplinary outpatient therapy or usual care. Few trials reported effects on quality of life or global assessments.ConclusionsThe reviewed trials provide evidence that intensive multidisciplinary biopsychosocial rehabilitation with functional restoration reduces pain and improves function in patients with chronic low back pain. Less intensive interventions did not show improvements in clinically relevant outcomes.

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