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Am Fam Physician. 2002;65(3):475

Chronic low back pain is a common and difficult problem caused by a combination of physical, psychologic, social, and occupational factors. Intensive multidisciplinary rehabilitation, including efforts to control these factors, has demonstrated pain reduction. Guzmán and associates assessed randomized controlled trials to confirm the benefits of multidisciplinary rehabilitation treatment in patients with low back pain.

Using methodologic guidelines approved by the Back Review Group of the Cochrane Collaboration, studies of patients with disabling back pain for more than three months in which at least one group received multidisciplinary biopsychosocial rehabilitation and another group (the control group) did not receive this intervention were considered for inclusion. Evaluation of an accepted treatment effect such as pain severity, functional status, quality of life, or employment status was also required. Methodologic quality and the clinical relevance of each study were evaluated.

The 10 studies chosen for the analysis included 1,964 patients with low back pain. The types of multidisciplinary rehabilitative therapy included inpatient and outpatient settings. Most of the therapy was individualized, while control participants received non-multidisciplinary rehabilitation, usual care, or no treatment. Intensive multidisciplinary rehabilitation with a functional restorative approach decreased pain and improved function. Less intensive programs had little impact on the same end points.

The authors conclude that involvement in a properly conducted, intensive, multidisciplinary rehabilitative program with functional restoration can help patients with chronic low back pain. Because these programs are expensive and the benefits are unclear, further cost-benefit analyses are needed.

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