Multidisciplinary Based Rehabilitation (MBR) Compared with Active Physical Interventions for Pain and Disability in Adults with Chronic Pain. A Systematic Review and Meta-analysis

OBJECTIVE This systematic review and meta-analysis examined the effectiveness of multidisciplinary based rehabilitation (MBR) in comparison to active physical interventions for adults with chronic pain. METHODS The review was conducted in line with the recommendations provided in the Cochrane handbook for systematic reviews and is reported in accordance with the PRISMA guidelines. Eight electronic databases were searched from inception to November 2018. Only randomised controlled trials were eligible for inclusion. In total, 31 trials were identified and most studies involved patients with chronic low back pain (25 trials). The main outcomes considered were pain intensity and disability at short-term follow-up (≤3▒mo post treatment), medium-term (>3▒mo and <12▒mo) and long-term follow-up (≥12▒mo). The quality of the evidence was assessed according to the GRADE approach. RESULTS Twenty-seven studies were included in the meta-analysis. Statistically significant differences, in favour of MBR were found for pain intensity and disability at short-term (SMD=0.53 and 0.50) and long-term follow-up (SMD=0.56 and SMD 0.77) but the quality of the evidence was low. There was no significant difference between MBR and active physical interventions in the medium-term. CONCLUSION Overall the results suggest that MBR may lead to greater improvements in pain intensity and disability compared to active physical interventions and the effects appear to be sustained in the long-term. However, these findings should be interpreted with caution in light of the low quality of the evidence, with all but one trial judged to be at high risk of bias. Further research is required to assess the effectiveness of MBR for people with chronic pain conditions other than low back pain, such as fibromyalgia and complex regional pain syndrome.