| Author, Year, Followup,a Pain Duration, Study Quality | Intervention | Population | Function and Pain Outcomes | Other Outcomes |
|---|---|---|---|---|
Abbassi, 2012259 10.25 months Duration of pain: ~6 years Poor | A. Multidisciplinary rehabilitation (n=12), 7 sessions over 7 weeks B. Multidisciplinary pain management (spouse-assisted) (n=10). 7 sessions over 7 weeks C: Usual care (n=11) | A + B + C Overall Age (mean): 45 years Female: 88% A vs. B vs. C Baseline RDQ (0–24): 12.1 vs. 11.2 vs. 8.4 Baseline pain (0-10 VAS): 4.6 vs. 5 vs. 3.6 | A vs. B vs. C 10.25 months RDQ (0–24): 8.8 vs. 8.2 vs. 10.4, p=0.44 Pain (0–10 VAS): 3.7 vs. 2.8 vs. 4.3, p=0.44 | NR |
Bendix, 1995,270 1997,280 1998281 60 months Duration of pain: >6 months Fair | A. Multidisciplinary rehabilitation (n=40), 18 sessions over 6 weeks (total ~135 hours) B. Multidisciplinary rehabilitation (n=35), 12 sessions over 6 weeks (total 24 hours) C. Exercise (n=31) | A vs. B vs. C Age: 40 vs. 44 vs. 42 Female: 75% vs. 77% vs. 74% Baseline pain (0-10 NRS): 5.3 vs. 5.9 vs. 5.4 Baseline Low Back Pain Rating Scale (0-30): 15.5 vs. 15.3 vs. 14.4 | A vs. B vs. C 3.25 months Back pain (0-10 NRS): 2.7 vs. 5.6 vs. 4.4, p<0.001 Low Back Pain Rating Scale (0-30): 8.5 vs. 16.1 vs. 13.5, p=0.002 12 months Back pain (0-10 NRS): 3.3 vs. 6.5 vs. 5.3, p=0.005 Low Back Pain Rating Scale (0-30): 8.9 vs. 16.4 vs. 13.7, p<0.001 24 months Back pain (0-10 NRS): 3 vs. 6 vs. 5, p=0.08 Low Back Pain Rating Scale (0-30): 10 vs. 17 vs. 14, p=0.003 60 months Back pain (0-10 NRS): 4 vs. 6 vs. 5, p=0.3 Low Back Pain Rating Scale (0-30): 8 vs. 16 vs. 14, p=0.02 | A vs. B vs. C 3.25 months Days of sick leave: 25 vs.122 vs. 13, p=0.005 Healthcare system contacts: 0.5 vs. 2.8 vs. 1.3, p=0.05 12 months Days of sick leave: 52 vs. 295 vs. 100, p=0.002 Healthcare system contacts: 4.5 vs. 12.0 vs. 11.8, p=0.002 Days of sick leave: 2.5 vs. 37 vs. 11, p=0.06 24 months Healthcare system contacts: 5 vs. 21 vs. 14, p=0.03 Overall assessment (1-5): 2 vs. 3 vs. 3, p=0.005 60 months Overall assessment (1-5): 2 vs. 3 vs. 3, p=0.004 Increase in proportion able to work: 30% vs. 23% vs. 0%, p=0.001 Days of sick leave: 13 vs. 11 vs. 88, p=0.2 Healthcare system contacts: 15 vs. 10 vs. 24, p=0.2 Back surgery: 5% vs. 10% vs. 10%, p=0.7 |
60 months Duration of pain: >6 months Fair | A. Multidisciplinary rehabilitation (n=55), 18 sessions over 6 weeks (total ~135 hours) B. Usual care (n=51) | A vs. B Age 41 vs.40 years Female: 71% vs. 69% Baseline pain (0-10 NRS): 6.1 vs. 6.1 Baseline Low Back Pain Rating Scale (0-30): 16.9 vs. 15.9 | A vs. B 3.25 months Back pain (0-10 NRS): 5.7 vs. 6.9, p=0.05 Low Back Pain Rating Scale (0-30): 12.1 vs. 16.8, p<0.001 24 months Back pain (0-10 NRS): 6 vs. 6.5, p=0.5 Low Back Pain Rating Scale (0-30): 16 vs. 15, p=0.9 60 months Back pain (0-10 NRS): 5 vs. 5, p=1.0 Low Back Pain Rating Scale (0-30): 12 vs. 16, p=0.2 | A vs. B 3.25 months Days of sick leave: 10 vs. 122, p=0.02 Contacts to health-care system: 1.6 vs. 5.3, p<0.001 24 months Days of sick leave: 15 vs. 123, p<0.001 Healthcare system contacts: 12 vs. 26, p<0.001 60 months Days of sick leave: 10 vs. 50, p=0.4 Healthcare system contacts: 16 vs. 48, p=0.1 Back surgery: 7% vs. 12%, p=0.4 |
Bendix, 2000271 10 months Duration of pain: Not reported Fair | A. Multidisciplinary rehabilitation (n=59), 18 sessions over 8 weeks (total ~139 hours) B. Exercise (n=68) | A vs. B Age: 40 vs. 43 years Female: 66% vs. 65% Baseline function: NR Baseline pain: NR | A vs. B 10 months Back pain (0–10): 5.1 vs. 5.7, p=0.33 Low Back Pain Rating Scale (0–30 ADL): 12 vs. 13, p=0.41 | A vs. B 10 months Overall assessment (1–5): 1.7 vs. 2.7, p=0.03 Work capable: 75% vs. 69%, p=0.64 Healthcare contacts (number): 2.5 vs. 4, p=0.28 |
Harkapaa, 1989256 1 month Duration of pain: >2 years Poor | A. Multidisciplinary rehabilitation (inpatient) (n=156), 3 weeks (number of sessions and total hours unclear) B. Multidisciplinary rehabilitation (outpatient) (n=150), 15 sessions over 8 weeks (total hours unclear) C. Usual care (n=153) | A vs. B vs. C Age: 45 vs. 45 vs. 45 years Female: 37% vs. 39% vs. 35% Baseline function, LBP Disability Index (0-45): 16.7 vs. 17.6 vs. 16.7 Baseline Pain Index (0-400): 184.9 vs. 178.6 vs. 175.8 | A vs. B vs. C 1 month LBP Disability Index (0-45): 13.8 vs. 14.7 vs. 17.3, p<0.004 for A vs. C and p<0.01 for B vs. C Pain Index (0-400): 127 vs. 145 vs. 160, p<0.001 for A vs. C and p<0.04 for B vs. C | NR |
Jousset, 2004272 5 months Duration of pain: >4 months Poor | A. Multidisciplinary rehabilitation (n=44), 25 sessions over 5 weeks (total 150 hours) B. Exercise (n=42) | A vs. B Age: 41 vs. 40 years Female: 30% vs. 37% Baseline function Quebec Disability Scale (0-100): 34.6 vs. 31.6 Baseline pain (0-10 NRS): 5.0 vs. 4.6 | A vs. B 5 months Quebec Disability Scale (0-100): 22.0 vs. 22.9, p=0.80 Pain (0-10 NRS): 3.1 vs. 4.0, p=0.01 Dallas Pain Questionnaire ADL (0-100): 36.7 vs. 41.5, p=0.36 | A vs. B 5 months Hospital Anxiety Depression Scale (0-21): 12.7 vs. 13.4 (6.4), p=0.62 Dallas Pain Questionnaire Social interest (0-100): 19.6 vs. 24.3, p=0.37 |
Lambeek 2010258 9 months Duration of pain: >4 months Fair | A. Multidisciplinary rehabilitation (n=66), 26+ sessions over up to 13 weeks (total hours unclear) B. Usual care (n=68) | A vs. B Age: 46 vs. 47 years Female: 44% vs. 40% Baseline modified RDQ (0-23): 14.7 vs. 15.0 Baseline pain (0-10 VAS): 5.7 vs. 6.3 | A vs. B 3 months Modified RDQ (0-23): 4.8 vs. 5.0 (0.9), adjusted difference 0.06, 95% CI −2.3 to 2.5 Pain (0-10 VAS): 1.3 vs. 2.3, adjusted difference 0.5, 95% CI −0.6 to 1.6 9 months Modified RDQ (0-23): 7.2 vs. 4.4, adjusted difference −2.9, 95% CI −4.9 to −0.9 Pain (0-10 VAS): 1.6 vs. 1.9, adjusted difference 0.21, 95% CI −0.8 to 1.2 | A vs. B 9 months General practitioner visits (# of patients): 13 vs. 29 Medical specialist visits (# of patients): 13 vs. 29 Total costs (pounds): 13,165 (SD 13,600) vs. 18,475 (SD 13,616), difference −5,310 (95% CI −10,042 to −391) |
Monticone 2013276 23 months Duration of pain: 25 vs. 26 months Fair | A. Multidisciplinary rehabilitation (n=45), 26 sessions over 5 weeks (total 26 hours) B. Exercise (n=45) | A vs. B Age: 49 vs. 50 years Female: 60% vs. 56% Baseline RDQ (0-24): 15.3 vs. 15.0 Baseline pain (0-10 VAS): 7.0 vs. 7.0 | A vs. B 11 months RDQ (0-24): 1.3 (1.6) vs. 11.0 (2.0) Pain (0-10 VAS): 1.4 (1.1) vs. 5.3 (1.2) 23 months RDQ (0-24): 1.4 vs. 11.1, difference −9.7, 95% CI −10.4 to −9.0 Pain (0-10 VAS): 1.5 vs. 6.2, difference −4.7, 95% CI −5.1 to −4.3 | A vs. B 11 months SF-36 physical pain (0-100): 79.0 (14.6) vs. 52.0 (16.2) SF-36 physical functioning (0-100): 85.7 (19.6) vs. 62.1 (19.4) SF-36 general health (0-100): 85.0 (13.8) vs. 56.4 (15.9) SF-36 mental health (0-100): 89.8 (13.0) vs. 54.1 (11.9) 23 months SF-36 physical pain: 80.4 vs. 61.8, difference 18.6, 95% CI 12.8 to 24.3 SF-36 physical functioning (0-100): 87.6 vs. 65.0, difference 22.6, 95% CI 15.0 to 30.1 SF-36 general health: 86.3 vs. 63.1, difference 23.2, 95% CI 17.3 to 29.1 SF-36 mental health: 91.0 vs. 58.8, difference 32.2, 95% CI 27.4 to 37.0) |
Monticone 2014277 3 months Duration of pain: 15 vs. 14 months Fair | A. Multidisciplinary rehabilitation (n=10), 16 sessions over 8 weeks (total 16 hours) B. Exercise (n=10) | A vs. B Age: 59 vs. 57 years Female: 7% vs. 4% Baseline function (0-100 ODI): 26 vs. 24 Baseline pain (0-10 NRS): 5 vs. 4 | A vs. B 3 months ODI (0-100): 8 vs. 15, p=0.027 Pain (0-10 NRS): 2 vs. 3, p=1.0 | A vs. B 3 months SF-36 bodily pain (0-100): 65 vs. 55, p=0.261 SF-36 general health (0-100): 71 vs. 55, p=0.018 SF-36 social function (0-100): 81 vs. 61, p=0.001 SF-36 emotional role (0-100): 77 vs. 57, p=0.007 SF-36 mental health (0-100): 88 vs. 67, p=0.001 |
Nicholas, 1991273 11 months Duration of pain: 7 years Poor | A. Multidisciplinary rehabilitation (cognitive treatment) (n=10) B. Multidisciplinary rehabilitation (behavioral treatment) (n=10) C. Multidisciplinary rehabilitation (cognitive treatment and relaxation treatment) (n=8) D. Multidisciplinary rehabilitation (behavioral treatment and relaxation training) (n=9) E. Exercise + attention control (psychologist-led group discussions) (n=10) F. Exercise (n=11) For all multidisciplinary rehabilitation interventions, 19 sessions over 5 weeks (total 21.5 hours) | Overall Age: 41 years Female: 51% A vs. B vs. C vs. D vs. E vs. F Baseline function, (0-100 Sickness Impact Profile): 37.13 vs. 34.24 vs. 33.41 vs. 20.53 vs. 27.12 vs. 28.06 Baseline pain (0-5 categorical scale): 2.78 vs. 2.96 vs. 3.80 vs. 2.27 vs. 2.84 vs. 2.77 | A vs. B vs. C vs. D vs. E vs. F 5 months Sickness Impact Profile (0-100): 24.42 (11.78) vs. 15.44 (14.12) vs. 25.69 (8.50) vs. 14.86 (9.08) vs. 19.40 (6.89) vs. 29.78 (8.76) Pain (0-5 categorical scale): 2.18 (0.55) vs. 1.87 (0.73) vs. 3.20 (0.93) vs. 2.22 (0.48) vs. 2.64 (0.90) vs. 3.18 (0.72) 11 months Sickness Impact Profile (0-100): 23.85 (12.50) vs. 12.80 (8.62) vs. 20.77 (8.29) vs. 12.87 (6.68) vs. 18.94 (12.79) vs. 25.18 (8.08) Pain (0-5 categorical scale): 2.56 (0.97) vs. 2.66 (1.06) vs. 3.30 (0.83) vs. 1.88 (0.65) vs. 2.70 (0.84) vs. 3.22 (0.69) | A vs. B vs. C vs. D vs. E vs. F 5 months Spielberger State Anxiety Inventory (20-80): 57.17 (10.30) vs. 37.57 (12.92) vs. 55.71 (10.47) vs. 36.40 (6.28) vs. 41.13 (11.70) vs. 54.00 (12.03) Beck Depression Inventory (0-63): 18.67 (9.01) vs. 8.14 (5.77) vs. 16.14 (3.80) vs. 9.00 (6.07) vs. 9.88 (5.46) vs. 19.17 (8.78) Medication use (0-5): 1.50 (1.26) vs. 0.57 (0.73) vs. 1.86 (0.64) vs. 1.60 (1.02) vs. 1.50 (0.71) vs. 1.83 (1.07) 11 months Spielberger State Anxiety Inventory (20-80): 42.83 (9.42) vs. 37.43 (12.26) vs. 47.17 (17.01) vs. 40.67 (11.81) vs. 46.56 (11.51) vs. 53.40 (18.78) Beck Depression Inventory (0-63): 18.67 (10.04) vs. 8.00 (5.93) vs. 12.83 (6.69) vs. 13.17 (8.51) vs. 10.56 (5.21) vs. 17.60 (6.09) Medication use (0-5): 1.17 (1.37) vs. 0.71 (0.88) vs. 1.67 (1.37) vs. 1.33 (0.75) vs. 1.44 (0.96) vs. 1.60 (1.49) |
Nicholas, 1992274 5 months Duration of pain: 5.5 years Fair | A. Multidisciplinary rehabilitation (n=10), 18 sessions over 5 weeks, (total 31.5 hours) B. Exercise + attention control (psychologist-led group discussions) (n=10) | Overall Age: 44 years Female: 45% A vs. B Baseline function (0-100 Sickness Impact Profile): 30.87 vs. 32.10 Baseline pain (0-5 categorical scale): 3.13 vs. 2.84 | A vs. B 5 months Pain intensity (0-5 categorical scale): 2.89 (0.64) vs. 2.75 (1.11) | A vs. B 5 months Beck Depression Inventory (0-63): 14.44 (5.98) vs. 18.50 (9.26) Using medication: 44% vs. 88% |
10.75 months Duration of pain: >4 months Fair | A. Multidisciplinary rehabilitation (n=68), 25 sessions over 5 weeks (total 150 hours) B. Exercise therapy (n=64) | A vs. B Age: 41 vs. 39 years Female: 32% vs. 38% Baseline function (0-100 Dallas Pain Questionnaire daily activities (0-100): 51.8 vs. 51 Baseline Pain (0-10 VAS): 4.7 vs. 4.5 | A vs. B 10.75 months Dallas Pain Questionnaire daily activities (0-100): 31.4 vs. 39.1, difference −7.7 (95% CI −16.15 to 0.75) Pain (0-10 VAS): 2.9 vs. 3.5, difference −0.6 (95% CI −1.49 to 0.29) | A vs. B 10.75 months Dallas Pain Questionnaire anxiety/depression (0-100): 21.9 vs. 25.5, difference −3.6 (95% CI −12.56 to 5.36) |
Strand, 2001260 11 months Duration of pain: 10 vs. 9 years Fair | A. Multidisciplinary rehabilitation (n=81), 20 sessions over 4 weeks (total 120 hours) B. Usual Care (n=36) | A vs. B Age: 45 vs. 42 years Female: 59% vs. 64% Baseline function (0-100 Disability Rating Index): 55.6 vs. 58.3 Baseline pain (0-100 VAS): 48.3 vs. 53.0 | A vs. B 11 months Disability Rating Index (0-100): −27.3 (95% CI −34 to −21) vs. −3.3 (95 % CI −10 to 14) vs. −16.4 (95% CI −26 to −7.3) vs. 0.2 (95% CI −14 to 14), difference −3.8 (95% CI −13.9 to 6.3) Pain (0-100 VAS): −21.1 (95% CI −31 to −11) vs. −2.3 (95% CI −9.4 to 4.8) vs. −23.1 (95% CI −37 to 9.2) vs. 7.1 (95% CI −7.7 to 22), difference −1.0 (95% CI −11.7 to 9.6) | A vs. B 11 months Working: 47% vs. 58% difference −11% (95% CI −8 to 30) |
Tavafian, 2008269 12 months Duration of pain: 9 months Poor | A. Multidisciplinary program (n=37), 5 sessions over 0.5 weeks (total hours unclear) B. Medications (acetaminophen, NSAID and chlordiazepoxide) (n=37) | A vs. B Age: 43 vs. 45 years Female, %: 100 vs. 100 Baseline SF-36 Physical (0-100): 41.2 vs. 42.3 Baseline SF-36 Mental (0-100): 47.5 vs. 47.7 | NR | A vs. B 3 months SF-36 Physical (0-100): 76.7 vs. 51.2, difference 25.5 (95% CI 14.69 to 36.31) SF-36 MCS (0-100): 80.4 vs. 57.4, difference 23.0 (95% CI 10.78 to 35.22) 6 months SF-36 PCS (0-100): 66.6 vs. 51.2, difference 15.4 (95% CI 2.35 to 28.45) SF-36 MCS (0-100): 66.9 vs. 57.9, difference 9.0 (95% CI −3.88 to 21.88) 6 months SF-36 PCS (0-100): 64.7 vs. 51.1, difference 13.6 (95% CI −1.48 to 28.68) SF-36 MCS (0-100): 65.1 vs. 60.2, difference 4.9 (95% CI −7.57 to 17.37) |
Turner, 1990133 12 months Duration of pain: 12.9 years Poor | A. Multidisciplinary rehabilitation (n=24), 16 sessions over 2 weeks (total 32 hours) B. Exercise (n=24) | Overall Age: 44 years Female: 48% A vs. B Baseline function (Sickness Impact Profile): 8.5 vs. 8.4 Baseline pain (0-78 MPQ): 25.5 vs. 19.4 | A vs. B 6 months Sickness Impact Profile (0-100): 4.5 vs. 6.3 McGill Pain Questionnaire Pain Rating Index (0-78): 13.3 vs. 15.7 12 months Sickness Impact Profile (0-100): 4.8 vs. 4.7 McGill Pain Questionnaire Pain Rating Index (0-78): 18.2 vs. 14.9 | A vs. B 6 months Center for Epidemiologic Studies-Depression Scale (0-60): 8.3 vs. 9.3 12 months Center for Epidemiologic Studies-Depression Scale (0-60): 10.0 vs. 9.3 |
van der Roer, 2008275 10 months Duration of pain: ~50 weeks Fair | A. Multidisciplinary rehabilitation (n=60), 30 sessions over 10 weeks (total hours unclear) B. Exercise (n=54) | A vs. B Age: 42 vs. 42 years Female: 55% vs. 48% Baseline function RDQ (0-24): 11.6 vs. 12.1 Baseline pain (0-10 NRS): 6.2 vs. 5.9 | A vs. B 4 months RDQ (0-24): 7.4 vs. 7.7, adjusted difference 0.13 (95% CI −2.24 to 2.50) Pain (0-10 NRS): 4.1 vs. 4.8, adjusted difference −0.97 (95% CI −1.88 to −0.06) 10 months RDQ (0-24): 6.7 vs. 7.1, adjusted difference 0.06 (−2.22 to 2.34) Pain (0-10 VAS): 3.9 vs. 4.6, adjusted difference −1.02 (−2.14 to 0.09) | A vs. B 4 months Global Perceived Effect positive (%): 38.2% vs. 39.8%, OR 0.93 (95% CI 0.36 to 2.43) 10 months Global Perceived Effect positive (%): 45.0% vs. 32.3%, OR 1.71 (95% CI 0.67 to 4.38) |
Von Korff, 2005257 22.5 months Duration of pain: >3 months Fair | A. Multidisciplinary rehabilitation (n=119), 4 sessions over 5 weeks (total 4 hours) B. Usual care (n=121) | A vs. B Age: 50 vs. 50 years Female: 65% vs. 60% Modified RDQ (0-23): 12.3 vs. 11.4 Baseline pain (0-10 NRS): 5.7 vs. 5.8 | A vs. B 4.5 months Function Modified RDQ (0-23): 9.2 (6.6) vs. 10.1 (6.4), p=0.0003 >1/3 reduction in RDQ: 42.2% vs. 23.7%, adjusted OR 3.5, p=0.0007 Pain (0-10 NRS): 4.2 (2.0) vs. 4.7 (2.2), p=0.007 10.5 months Modified RDQ (0-23): 8.4 vs. 9.1, p=0.0063 >1/3 reduction in RDQ: 44.6% vs. 22.7%, adjusted OR 2.1, p=0.03 Pain (0-10 NRS): 4.0 vs. 4.7, p=0.004 22.5 months Modified RDQ (0-23): 8.1 vs. 9.1, p=0.0078 >1/3 reduction in RDQ: 49.4% vs. 37.0%, adjusted OR 1.8, p=0.08 Pain (0-10 NRS): 4.3 vs. 4.6, p=0.115 | A vs. B 4.5 months SF-36 Social Functioning (0-100): 74.4 vs. 73.6, p=0.26 SF-36 Mental Health (0-100): 70.3 vs. 69.5, p=0.23 10.5 months SF-36 Social Functioning (0-100): 74.4 vs. 73.6, p=0.26 SF-36 Mental Health (0-100): 70.3 vs. 69.5, p=0.23 22.5 months SF-36 Social Functioning (0-100): 76.7 vs. 76.3, p=0.28 SF-36 Mental Health (0-100): 71.0 vs. 72.4, p=0.98 |
ADL = activity of daily living; CI = confidence interval; LBO = Low Back Outcome Score; LBP = low back pain; MCS = Mental Component Summary; MPQ = McGill Pain Questionnaire; NR = not reported; NRS = Numerical Rating Scale; NSAID = nonsteroidal anti-inflammatory drug; ODI = Oswestry Disability Index; PCS = Physical Component Summary; RDQ = Roland-Morris Disability Questionnaire; SF-36 = Short-Form 36Q; VAS = visual analog scale
Unless otherwise noted, followup time is calculated from the end of the treatment period
From: Results
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