Multidisciplinary treatment programmes (subacute low back pain)
In this section:
Return to work
Compared with usual care Multidisciplinary treatment, with or without a workplace visit, may be more effective than usual care at reducing sick leave in people with subacute low back pain. However, evidence was weak and interventions varied between studies (very low-quality evidence).
For GRADE evaluation of interventions for low back pain (acute), see table.
We found two systematic reviews (search date 2002, 2 RCTs, 233 people with subacute low back pain, duration between 4 weeks and 3 months; 1998–2006, 2 RCTs, 928 people with subacute low back pain, duration 5–12 weeks).
The first review found that multidisciplinary treatment, including a workplace visit, significantly reduced sick leave compared with usual care (time to return to work: 10 weeks with multidisciplinary treatment v 15 weeks with usual care in first RCT; RR for return to work rate 2.4, 95% CI 1.2 to 4.9 in second RCT). However, both studies identified in the review were of low quality; methodological deficiencies included lack of blinding, reporting of co-interventions, and unclear reporting of loss to follow-up.
The second review included two studies excluded from the first review as not being multidisciplinary (see comments). The first included RCT (457 people, low back pain 8–12 weeks) included in the review used an intervention of light mobilisation and individualised information on prognosis and activity in the setting of a university clinic, while the control was people in primary care. The review reported that the intervention group had an earlier return to work at 1 year (OR 1.60; CI, P value, and absolute numbers not reported), but differences between groups diminished over the second year (reported as not significant; P value not reported). In the third year, sick leave was 127.7 days with the intervention compared with 169.6 days with control (statistical analysis between groups not reported). In the second included study (489 people, described as subchronic low back pain, initial sick leave of 5–11 weeks), consecutive people were assigned by alternate allocation to intervention or control. Control was not specified in the review. The intervention group received a light mobilisation programme based on education and advice, and monitoring of conventional treatment. The review reported that the intervention significantly improved return to work compared with control at 5 years (based on data from an insurance office: 81% with intervention v 66% with control; absolute numbers not reported; P <0.001). The review reported that during the follow-up period, 72% of people in the intervention group and 74% of people in the control group had sickness absence because of low back pain (statistical analysis between groups not reported). However, this study was by alternate allocation and the results should be interpreted with caution.
The first review included inpatient and outpatient programmes that were multidisciplinary. To be multidisciplinary they had to consist of a physician's consultation plus either a psychological, social, or vocational intervention, or any combination. Trials in which rehabilitation was exclusively or predominantly medical were excluded, and back schools were also excluded from the review. However, multidisciplinary programmes do not always include a psychosocial aspect as is evident in the second review. The second review defined multidisciplinary interventions as those involving two or more healthcare disciplines.
Multidisciplinary rehabilitation programmes are typically expensive and may not be necessary for uncomplicated acute low back problems. Multidisciplinary programmes are typically taken to comprise treatments provided by two or more healthcare providers with different professional training to obtain different perspectives and approaches to recovery. The term multidisciplinary does not imply a mandatory roster of specialists and does not dictate the nature of the treatment.
Web publication date: 9 May 2011 (based on December 2009 search)