Treatment Efficacy, Clinical Utility, and Cost-Effectiveness of Multidisciplinary Biopsychosocial Rehabilitation Treatments for Persistent Low Back Pain: A Systematic Review

Abstract

Study Design: Systematic review. Objectives: To review the current literature on the treatment efficacy, clinical utility, and cost-effectiveness of multidisciplinary biopsychosocial rehabilitation (MBR) for patients suffering from persistent (nonspecific) lower back pain (LBP) in relation to pain intensity, disability, health-related quality of life, and work ability/sick leave. Methods:We carried out a systematic search of Web of Science, Cochrane Library, PubMed Central, EMBASE, and PsycINFO for English-and German-language literature published between January 2010 and July 2017. Study selection consisted of exclusion and inclusion phases. After screening for duplication, studies were excluded on the basis of criteria covering study design, number of participants, language of publication, and provision of information about the intervention. All the remaining articles dealing with the efficacy, utility, or cost-effectiveness of intensive (more than 25 hours per week) MBR encompassing at least 3 health domains and cognitive behavioral therapy-based psychological education were included. Results:The search retrieved 1199 publications of which 1116 were duplicates or met the exclusion criteria. Seventy of the remaining 83 articles did not meet the inclusion criteria; thus 13 studies were reviewed. All studies reporting changes in pain intensity or disability over 12 months after MBR reported moderate effect sizes and/or p-values for both outcomes. The effects on health-related quality of life were mixed, but MBR substantially reduced costs. Overall MBR produced an enduring improvement in work ability despite controversy and variable results.Conclusions: MBR is an effective treatment for nonspecific LBP, but there is room for improvement in cost-effectiveness and impact on sick leave, where the evidence was less compelling.

Influences of Sex, Education, and Country of Birth on Clinical Presentations and Overall Outcomes of Interdisciplinary Pain Rehabilitation in Chronic Pain Patients: A Cohort Study from the Swedish Quality Registry for Pain Rehabilitation (SQRP)

“…Systematic reviews (SRs) report higher efficacy on a general level for specific outcomes of IMMRPs and with respect to reduced costs compared with single treatment or treatment-as-usual programs [10,[12][13][14][15][16][17][18]. However, striving to detect causal relationships, SRs, and randomized controlled trials (RCTs) may suffer from various degrees of bias [19][20][21].…”

Cost–utility analysis of antibiotic treatment in patients with chronic low back pain and Modic changes: results from a randomised, placebo-controlled trial in Norway (the AIM study)

“…26 Comparisons with other health-economic studies on chronic lbP There is little evidence on cost-utility of medications for chronic LBP. Such evidence was neither found in two systematic reviews from 2011 in which trials with cost-effectiveness evaluations of guideline-endorsed treatments 16 and GP care 15 for LBP were summarised, nor in the two recent systematic reviews of the health-economic effects of exercises 25 and multidisciplinary rehabilitation 29 for LBP. To our knowledge, there is no cost-effectiveness or cost-utility study on pharmacotherapy for chronic LBP, with or without Modic changes.…”

Feasibility of the biopsychosocial primary care intervention ‘Back on Track’ for patients with chronic low back pain: a process and effect-evaluation

“…For patients with chronic low back pain (CLBP) interdisciplinary biopsychosocial rehabilitation programs (IBRPs) have been developed showing moderate but promising effects [1,2]. The general aim of IBRPs is to modify pain cognitions, stimulate active coping behaviour, and improve the level of functioning despite pain.…”