Table 1.
Participants, interventions, and outcomes assessed in 10 randomised controlled trials of multidisciplinary treatments for chronic low back pain (LBP)
| Author, year of index publication | Participants* | Multidisciplinary intervention | Comparison treatment | Outcomes measured | Notes |
|---|---|---|---|---|---|
| Alaranta, 199415 | 293 workers with LBP for ⩾6 months in Finland selected by insurer | 126 h inpatient functional restoration and a home programme | Three week inpatient programme. PM, exercises, back school | Insurance records, mobility, strength, pain, function, and psychological scales at 3 and 12 months | Workers less disabled than in other trials |
| Basler, 199725 | 94 patients with chronic LBP referred to three pain clinics in Germany | 12 cognitive-behavioural sessions plus usual medical treatment at the clinic | Usual medical treatment at clinic | Self reported pain, function, medication intake, and coping with pain immediately after treatment | Only short term follow up available, as control patients received intervention afterwards |
| Bendix, 199618 | 106 patients with LBP ⩾6 months, unemployed or on sick leave, referred to back centre in Denmark | 135 h outpatient functional restoration | Not treated at back centre; could go anywhere else for treatment | Back endurance and self reported pain, function, employment status, and contacts with healthcare system over 5 years | Outcomes at 4 months, 2 years, and 5 years reported in separate articles |
| Bendix, 199517 | 132 patients with LBP ⩾6 months, unemployed or on sick leave, referred to back centre in Denmark | Two interventions: 135 h outpatient functional restoration, or 24 h outpatient psycho-physical training | 24 h outpatient physical training plus back school | Back endurance and self reported pain, function, employment status, and contacts with healthcare system over 5 years | Outcomes at 4 months, 1 year, 2 years, and 5 years reported in separate articles |
| Harkäpää, 198921 | 476 blue collar workers with chronic or recurrent LBP ⩾2 years in Finland, selected by insurer | Two interventions: 3 weeks of inpatient PM, massage, exercise, relaxation, or 15 outpatient sessions of PM, exercise, relaxation | Assessment by a specialist in physical medicine plus printed and oral advice | Insurance records, mobility, strength, self reported pain, disability, and overall benefit over 30 months | Outcomes at 3 months and 30 months reported in separate articles |
| Jückel, 199026 | 71 patients with LBP ⩾6 months, on waiting list to attend spa hospital in Germany | 4-6 weeks of inpatient hydrotherapy, PM, exercise, massage | Waiting list controls | Self reported pain, function, depression, and anxiety immediately after treatment | Only short term follow up available, as controls received intervention afterwards |
| Lukinmaa, 198916 | 209 patients with LBP >2 months, referred by general practitioners to regional hospital in Finland | 5 days of inpatient assessment followed by individualised treatment | 30 minute assessment and recommendations by orthopaedic surgeon and nurse | Insurance records and self reported pain, global improvement, R&M, and healthcare use over 12 months | A few patients had LBP <3 months, some were still employed |
| Mitchel, 199429 | 420 workers off work ⩾90 days after work injury, selected by insurer in Canada | 280 h outpatient functional restoration | Usual treatment in the community plus mailed advice to primary care provider | Insurance records over 2 years | Corey et al30 reported pain ratings and self reported employment status in a subset |
| Nicholas, 199228 | 20 patients with LBP >6 months, referred by pain clinic and physicians in Australia | 17.5 h outpatient cognitive-behavioral therapy, PM, education, and exercise | 17.5 h outpatient “attention control,” PM, education, and exercise | Self reported pain, SIP, medication use, pain beliefs, depression, self efficacy, and coping over 6 months | Extensive assessment, numerous dropouts |
| Nicholas, 199127 | 58 patients with LBP >6 months, referred by pain clinic and physicians in Australia | Four outpatient psycho-physical interventions of 17.5 h each | Two controls: 17.5 h outpatient “attention control”, education, and exercise, or education and exercise only | Self reported pain, SIP, medication use, pain beliefs, anxiety, depression, and coping over 12 months | Extensive assessment, numerous dropouts |
PM=physical modalities such as heat or cold applications and transcutaneos nerve stimulation (manual therapies and exercise are listed separately if described in the article); SIP=sickness impact profile; R&M=Roland and Morris disability index.
*
Number of patients with low back pain randomised in the trial, except for Alaranta 1994 (number noted is after excluding 85 patients for medical reasons) and Mitchel 1994 (number noted is after excluding workers allocated to a third clinic, because of protocol violations). The number of patients followed up varied depending on the outcome and follow up time considered. In studies that included patients with other chronic pain syndromes, only patientss with low back pain were counted.