Karjalainen K, Malmivaara A, van Tulder M, Roine R, Jauhiainen M, Hurri H, Koes B
Finnish Institute of Occupational Health, Topeliuksenkatu 41 aA, Helsinki, Finland.
Cochrane Database Syst Rev. 2000(3):CD002193. doi: 10.1002/14651858.CD002193.
Multidisciplinary biopsychosocial rehabilitation programs are widely applied for chronic low back pain patients. The biopsychosocial approach for low back pain could also be considered to prevent chronicity by carrying out the rehabilitation if the acute pain is prolonged. Nevertheless multidisciplinary treatment programmes are often laborious and long processes and require good collaboration between the patient, the rehabilitation team and the work place. By workplace visits and close relationship with occupational health care one might expect results in terms of patients working ability.
The objective of this systematic review was to determine the effectiveness of multidisciplinary rehabilitation for subacute low back pain among working age adults.
The reviewed studies for this structured Cochrane review were identified from electronic bibliographic databases, the Science Citation Index, reference checking and consulting experts in the rehabilitation field. The original search was planned and performed for more broad area of musculoskeletal disorders. Trials on subacute low back pain were separated afterwards.
From all references found in our original search we selected randomized controlled trials (RCTs) and non-randomized controlled clinical trials (CCTs). Trials had to assess the effectiveness of multidisciplinary rehabilitation for working age patients suffering from subacute low back pain (more than 4 weeks but less than 3 months). The rehabilitation program was required to be multidisciplinary, i.e.; it had to consist of a physician's consultation plus either a psychological, social or vocational intervention, or a combination of these.
Four blinded reviewers selected the randomized controlled trials and controlled trials that met the specified inclusion criteria. Two experts in the field of rehabilitation evaluated the clinical relevance and applicability of the findings of the selected studies to actual clinical use. Two other blinded reviewers extracted the data and assessed the main results and the methodological quality of the studies using standardized forms. Finally, a qualitative analysis was performed to evaluate the level of scientific evidence for the effectiveness of multidisciplinary rehabilitation.
After screening 1808 abstracts, and the references of 65 reviews, we found only 2 relevant studies that satisfied our criteria on subacute low back pain. They were both considered to be methodologically low quality randomized controlled trials. The clinical relevance of included studies was sufficient. The level of scientific evidence for the effectiveness of multidisciplinary rehabilitation was moderate on subacute low back pain showing that multidisciplinary rehabilitation which includes workplace visit or more comprehensive occupational health care intervention helps patients to return to work faster, makes sick leaves less and alleviates subjective disability.
REVIEWER'S CONCLUSIONS: We conclude that there is moderate evidence of positive effectiveness of multidisciplinary rehabilitation for subacute low back pain and workplace visit increases the effectiveness. But because this evidence is based on the trials that had some methodological shortcomings and several expensive multidisciplinary rehabilitation programmes are commonly used for common subacute low back problems, there is an obvious need for high quality trials in this field.
多学科生物心理社会康复项目广泛应用于慢性腰痛患者。对于急性疼痛持续时间延长的情况，也可考虑采用生物心理社会方法进行康复治疗以预防慢性化。然而，多学科治疗方案往往繁琐且耗时较长，需要患者、康复团队和工作场所之间密切协作。通过工作场所走访以及与职业健康护理机构建立紧密联系，有望在患者工作能力方面取得成效。
本系统评价的目的是确定多学科康复对工作年龄成年人亚急性腰痛的有效性。
本结构化Cochrane综述纳入的研究通过电子书目数据库、科学引文索引、参考文献核对以及咨询康复领域专家来确定。最初的检索计划是针对更广泛的肌肉骨骼疾病领域进行的。之后将关于亚急性腰痛的试验分离出来。
从我们最初检索到的所有参考文献中，我们选择了随机对照试验（RCT）和非随机对照临床试验（CCT）。试验必须评估多学科康复对患有亚急性腰痛（超过4周但少于3个月）的工作年龄患者的有效性。康复项目必须是多学科的，即必须包括医生会诊，再加上心理、社会或职业干预中的一种，或者这些干预的组合。
四位盲法评审员筛选出符合指定纳入标准的随机对照试验和对照试验。康复领域的两位专家评估所选研究结果在实际临床应用中的临床相关性和适用性。另外两位盲法评审员提取数据，并使用标准化表格评估研究的主要结果和方法学质量。最后，进行定性分析以评估多学科康复有效性的科学证据水平。
在筛选了1808篇摘要以及65篇综述的参考文献后，我们仅发现2项符合我们关于亚急性腰痛标准的相关研究。它们均被认为是方法学质量较低的随机对照试验。纳入研究的临床相关性足够。多学科康复对亚急性腰痛有效性的科学证据水平为中等，表明包括工作场所走访或更全面职业健康护理干预的多学科康复有助于患者更快重返工作岗位，减少病假天数并减轻主观残疾程度。
我们得出结论，有中等证据表明多学科康复对亚急性腰痛有积极效果，且工作场所走访可提高有效性。但由于该证据基于存在一些方法学缺陷的试验，并且一些昂贵的多学科康复项目常用于常见的亚急性腰痛问题，因此该领域明显需要高质量试验。
