Free
The Somatic Connection  |   May 2016
Multidisciplinary Biopsychosocial Rehabilitation Improves Outcomes for Patients With Chronic Low Back Pain
Author Notes
  • Western University of Health Sciences College of Osteopathic Medicine of the Pacific, Pomona, California 
Article Information
The Somatic Connection   |   May 2016
Multidisciplinary Biopsychosocial Rehabilitation Improves Outcomes for Patients With Chronic Low Back Pain
The Journal of the American Osteopathic Association, May 2016, Vol. 116, 327-328. doi:10.7556/jaoa.2016.068
The Journal of the American Osteopathic Association, May 2016, Vol. 116, 327-328. doi:10.7556/jaoa.2016.068
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.