Multidisciplinary biopsychosocial rehabilitation for neck and shoulder pain among working age adults: a systematic review within the framework of the Cochrane Collaboration Back Review Group

STUDY DESIGN: A systematic review of randomized controlled trials. OBJECTIVES: To evaluate the effectiveness of multidisciplinary biopsychosocial rehabilitation for neck and shoulder pain among working age adults. SUMMARY OF BACKGROUND DATA: Multidisciplinary biopsychosocial rehabilitation programs for neck and shoulder pain require substantial staff and financial resources. They are widely used, despite questionable evidence of their effectiveness. METHODS: The reviewed randomized controlled and controlled trials appraising the effectiveness of biopsychosocial rehabilitation for working age patients with neck and shoulder pain were identified by searching electronic bibliographic databases, checking references, and consulting experts in the rehabilitation field. Four blinded reviewers selected the trials. Two specialists on rehabilitation evaluated the clinical relevance. Two other blinded reviewers extracted the data and assessed the main results and the methodologic quality of the studies. A qualitative analysis was performed to evaluate the level of scientific evidence. RESULTS: After 1808 abstracts and the references of 65 reviews were screened, only two relevant studies were found that satisfied the criteria. One of these was considered a methodologically low-quality randomized controlled trial, and the other was a methodologically low-quality controlled clinical trial. The clinical relevance of included studies was satisfactory. The level of scientific evidence for the effectiveness of multidisciplinary biopsychosocial rehabilitation for neck and shoulder pain was limited. CONCLUSIONS: There appears to be little scientific evidence for the effectiveness on neck and shoulder pain of multidisciplinary biopsychosocial rehabilitation compared with other rehabilitation methods. There is an urgent need for high-quality trials in this field.     

Erratum to: Long-term results of surgery for lumbar spinal stenosis: a randomised controlled trial

European Spine Journal -     

Compliance and subjective relief by corset treatment in chronic low back pain

The aim of this questionnaire-based 12-month follow-up study of 113 patients was to elucidate patient compliance and subjective help achieved with a first, elastic or semirigid corset in chronic, idiopathic low back pain. Subjective help obtained from the corset was reported as excellent or good in 37% of the returned questionnaires. A total of 60% reported having worn the corset even during the preceding month. Low semirigid and elastic models were found to be better by the males and high semirigid ones by the females (p less than 0.001). Age, height, weight, body mass index, retirement or physical strenuousness of work showed no statistically significant correlation with the subjective relief gained from the corset. It is important that sufficient time be allocated to fitting the corset and that adequate information be provided about wearing the brace and about suitable trunk exercises.     

Referred limb symptoms in chronic low back pain

Referred limb symptoms (RLS) in chronic low back pain patients without signs of root affections were studied in 212 men and 126 women, aged 36-55 years, who were at work, but suffered from chronic or recurrent low back pain. RLS during the past few months were experienced by 17% daily and 22% occasionally. Previous RLS were reported by 34%, whereas 27% had never had such symptoms. There was a 3:4 distribution between symptoms in right and left legs, and 30% claimed symptoms in both legs. The distal extension of RLS into the limbs was as follows: thigh 18%, leg 37%, foot 20%, and toes 26%. The nature of RLS comprised the following: pain 56%, numbness 50%, cramps 22%, sharp pain 15%, and weakness 10%. Occurrence of RLS was not related to age. In both men and women, RLS correlated with subjective disability as well as with pain on bendings and palpation of lumbar spine and muscles. Men with previous and present RLS had greater external rotation of the hips, but otherwise no specific physical measurements were related with RLS. RLS of both legs in women and of distal extension in men showed more findings related with back pain.     

Long-term results of surgery for lumbar spinal stenosis: a randomised controlled trial

We randomised a total of 94 patients with long-standing moderate lumbar spinal stenosis (LSS) into a surgical group and a non-operative group, with 50 and 44 patients, respectively. The operative treatment comprised undercutting laminectomy of stenotic segments, augmented with transpedicular-instrumented fusion in suspected lumbar instability. The primary outcome was the Oswestry disability index (ODI), and the other main outcomes included assessments of leg and back pain and self-reported walking ability, all based on questionnaire data from 85 patients at the 6-year follow-up. At the 6-year follow-up, the mean difference in ODI in favour of surgery was 9.5 (95% confidence interval 0.9–18.1, P-value for global difference 0.006), whereas the intensity of leg or back pain did not differ between the two treatment groups any longer. Walking ability did not differ between the treatment groups at any time. Decompressive surgery of LSS provided modest but consistent improvement in functional ability, surpassing that obtained after non-operative measures.     

Functional and clinical results after anterior interbody lumbar fusion

The functional and clinical results of anterior interbody lumbar fusion were assessed in 134 patients. Functional tests included spinal mobility and isokinetic trunk muscle strength measurements. The score rating system of the Japanese Orthopaedic association (JOA) and the Oswestry disability index were used for clinical evaluation. Functional results revealed decreased spinal flexibility when compared with normal values. A reduction in physical ability was also seen in the isokinetic trunk muscle measurements. Non-union seemed to have only little effect on the functional results. Patients under 20 years at operation had the best results, but beyond this threshold results did not vary with age. The JOA rating score was 25 or more in 50% of patients. The mean Oswestry disability index was 47.8 (range 1–82) preoperatively and 20 (range 0–68) at follow-up (P<0.001), indicating a clear decrease in subjective disability. Solid fusion was seen in 107 patients (80%) at follow-up.