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Effectiveness of primary care interventions using a biopsychosocial approach in chronic low back pain: a systematic review.

Research paper by Reni M A RMA van Erp, Ivan P J IPJ Huijnen, Marluuke L G MLG Jakobs, Jos J Kleijnen, Rob J E M RJEM Smeets

Indexed on: 06 Oct '18Published on: 06 Oct '18Published in: Pain Practice



Abstract

Recent systematic reviews show promising effects for multidisciplinary biopsychosocial (BPS) interventions in patients with chronic low back pain (CLBP). Nowadays, BPS interventions have also been developed for primary care physiotherapy settings. Our aim was to systematically review the evidence on the effectiveness of primary care BPS interventions in improving functional disability, pain and work status for patients with CLBP. Secondly, we aimed to provide an elaborated overview of BPS intervention designs, physiotherapist-training programs and process-related factors (practical implementation). We searched in scientific databases and reference lists. Randomized Controlled Trials (RCTs) evaluating primary care physiotherapist-led BPS interventions in adults (≥18 years) with non-specific CLBP (≥ 12 weeks) were included. Search resulted in 943 references; 7 RCTs were included (1,426 participants). Results show moderate quality evidence (3 trials; 991 participants) that a BPS intervention is more effective than education/advice for reducing disability and pain in the short-, medium-, and long-term. Low quality evidence (4 trials; 435 participants) was found for no difference with physical active treatments. BPS interventions seem more effective than education/advice, and as effective as physical activity interventions in patients with CLBP. BPS interventions with a clear focus on psychosocial factors (understanding pain, unhelpful thoughts, coping styles, and goal-setting) seem most promising. Sufficient delivery of BPS elements is expected when physiotherapist receive training programmes with extensive support prior and during delivery (manual, supervision, and informative resources). This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.