• M Bethge and W Müller-Fahrnow.
• Charité Universitätsmedizin Berlin, Lehrstuhl für Versorgungssystemforschung und Grundlagen der Qualitätssicherung in der Rehabilitation, Berlin. matthias.bethge@charite.de
• Rehabilitation (Stuttg). 2008 Aug 1;47(4):200-9.

BackgroundPrevious reviews concerning inpatient orthopaedic rehabilitation in Germany stated no convincing evidence of its effectiveness. However, work-related and behavioural-medicine concepts of rehabilitation have for several years been established in order to intensify and broaden conventional rehabilitation. But so far none of the previous studies had compared intensified and conventional rehabilitation within the framework of a systematic review of randomized controlled trials and used a meta-analytic approach.ObjectiveTo assess the effectiveness of intensified inpatient orthopaedic rehabilitation on clinically relevant outcomes in patients with musculoskeletal disorders.MethodsWe searched the following databases as of 26 November 2007: MEDLINE from 1966, EMBASE from 1989, PSYNDEX from 1977, PsycINFO from 1980. We included randomized controlled trials (RCTs) that had studied adults with musculoskeletal disorders, who had participated in intensified inpatient orthopaedic rehabilitation in Germany. Outcome measures were self-rated state of health, pain intensity, functioning, and days of sick leave. Standardised mean difference and associated 95% confidence interval were calculated. Cochran's Q statistic was used to assess the heterogeneity of the results, and the I (2) statistic was used to determine any inconsistency between the studies.ResultsFive relevant trials were identified in 15 publications. Four of them were considered to be high-quality RCTs. The trials identified reported 18 randomized comparisons of intensified orthopaedic rehabilitation and conventional orthopaedic rehabilitation. There is strong evidence that intensified rehabilitation improves self-rated state of health when compared with conventional rehabilitation at mid-term and long-term follow-up. There is moderate evidence that intensified rehabilitation with a psychological group intervention reduces pain intensity when compared with conventional rehabilitation at long-term follow-up. There is no evidence of reduced days of sick leave and improved functioning.ConclusionsThe relevant studies provide evidence that intensified rehabilitation improves self-rated state of health and reduces pain intensity in rehabilitants with musculoskeletal disorders.

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