Read Full Text: Multidisciplinary biopsychosocial rehabilitation for chronic low back pain: Cochrane systematic review and meta-analysis (Free to access)
Journal: BMJ Open
Year Published: 2015
Ranked 2nd on our 2015-2020 list of the 100 most influential OT-related articles
Low back pain is a leading cause of disability around the globe. Here in the US low back pain is the #1 cause of lost work days.
And, this week’s article really illuminates that OTs should not automatically punt these patients to be treated by our PT colleagues alone.
Back pain, like any type of pain, has biological, psychological, and social/environmental components. Due to such complexity, patients with LBP are likely best served by a team with diverse skill sets, which may include your occupational therapy expertise.
This systematic review examines multidisciplinary rehabilitation versus single-discipline interventions. The article found that multidisciplinary biopsychosocial rehabilitation interventions were more effective than usual care and physical treatments alone in decreasing pain and disability for patients with chronic low back pain.
Refresher on the biopsychosocial model
As the name implies, The biopsychosocial model is an interdisciplinary model that looks at the interconnection between the following factors:
- Biological
- Psychological
- Socio-environmental
This approach should sound extremely familiar to OT professionals, as we are accustomed to looking at patients from a holistic lens. At the same time, we have to remember that this can seem like a departure from the traditional medical model.
Two Club members, @mandy and @rafi, recently recorded a great podcast on the biopsychosocial approach: The Seniors Flourish Podcast: The Biopsychosocial Model and Occupational Therapy.
There is much to read about this model, as it has heavily influenced modern healthcare—but there are also critiques of the approach.
What was included in this systematic review?
The researchers sought out studies that met the following criteria:
1.) More than 75% of patients in the study reported LBP. Specific diagnoses included:
- Disc degeneration
- Bulging discs
- Facet joint dysfunction
- Sacroiliac joint pain
2.) The back pain was chronic, meaning that it had lasted longer than 3 months
3.) For the study, multidisciplinary rehabilitation was defined as being in alignment with the biopsychosocial model. Thus, a study was included if treatments included:
- A physical component
- A psychological component and/or a social/work-targeted component.
The components needed to be delivered by clinicians with different clinical backgrounds to be included in the study.
In reviewing studies that had been published prior to 2014, 41 trials were identified that met the inclusion criteria.
How was OT involved?
Occupational therapy was not mentioned explicitly in this article.
But, neither was PT.
In fact, I thought the article went out of its way not to mention specific professions. Instead, it emphasized the different training backgrounds and perspectives that are needed to address LBP. This aligns with a concept we explored last week, where the researchers seemed more concerned with WHAT was being done versus WHO was doing it.
What were the results?
Overall, the results of the systematic review were favorable for multidisciplinary care, but there was definitely nuance.
16 randomized controlled trials (RCTs) compared multidisciplinary rehab to usual care. Moderate evidence indicated that multidisciplinary care was more effective in reducing long-term pain and disability.
19 RCTs compared multidisciplinary care to physical treatments alone. Together, these showed low-quality evidence that multidisciplinary was more effective at reducing pain and disability.
Finally, my favorite was that 2 trials compared multidisciplinary care and surgery and found comparable outcomes—which is notable because surgery has more inherent risks.
These results (along with more that is spelled out in the article) were enough for the researchers to conclude that:
This systematic review provides evidence that multidisciplinary rehabilitation programmes are more effective than usual care (moderate-quality evidence) and physical treatments (low-quality evidence) in decreasing pain and disability in people with chronic low back pain.
Takeaways for OT practitioners
(These are my personal takeaways, and were not mentioned in the article.)
It makes sense that a more multifaceted approach to pain may be more effective…because pain itself is so multifaceted.
Pain management is a topic we’ve covered in the Club on multiple occasions already, and you’ll see that it appears several times on this year’s list of influential articles.
Pain science has been exploding over the past decade, and we are learning more and more about how complicated the experience of pain is. Throughout all of the research, the advice has been this: take an interdisciplinary approach.
I found this 2019 TED video to be really helpful in explaining how we currently understand pain, and you will see some familiar suggestions at the end:
If your facility is not taking a holistic approach to pain, it may be time for some changes.
There are fabulous functional restoration programs scattered across the nation, and they take a very systematic interdisciplinary approach to pain treatment. If you are like me and live in a rural area or small town, your facility might want to look into cost-effective options that can be provided locally. It seems to me that coupling OT and PT for pain management may be one of the most achievable and cost-effective ways to deliver interdisciplinary pain care.
If you are looking for more guidance on using the biopsychosocial approach for pain management, I highly recommend this 2018 continuing education article from the AOTA:
A Biopsychosocial Approach for Addressing Chronic Pain in Everyday Occupational Therapy Practice.
I will be curious to hear what kinds of pain management programs/systems you have in your area!
Listen to my takeaways in podcast form:
Find other platforms for listening to the OT Potential Podcast here.
(Possibly) Earn CEUs/PDUs for reading this article
Many of you can receive continuing education credits for reading this article. Here’s a form to help you do it, along with information to help you understand who qualifies.
And, here’s the full APA citation you many need:
Kamper, S. J., Apeldoorn, A. T., Chiarotto, A., Smeets, R. J. E. M., Ostelo, R. W. J. G., Guzman, J., & Tulder, M. W. V. (2015). Multidisciplinary biopsychosocial rehabilitation for chronic low back pain: Cochrane systematic review and meta-analysis. Bmj , 350 (feb18 5). doi: 10.1136/bmj.h444
it was amazing though! It helped my lBP in 3 weeks so I became a fan and then decided to get training. I only went to one session and got my exercises and that was all I needed. There are lots of you tube videos to see some of what it is about!