Dose or content? effectiveness of pain rehabilitation programs for patients with chronic low back pain. a systematic review

Pain, 10/21/2013

Waterschoot FPC, et al. - To systematically analyze the influence of dose of Pain Rehabilitation Programs (PRPs) for patients with Chronic Low Back Pain (CLBP) on disability, work participation and quality of life (QoL). Because dose variables were never studied separately or reported independently, the authors were not able to disentangle the relationship between dose, content and effects of PRPs on disability, work participation and QoL.

Methods

  • Literature searches were performed in PUBMED, Cochrane library, Cinahl and EMBASE up to October 2012, using MeSH terms, other relevant terms and free text words.
  • RCT’s in English, Dutch and German, analyzing the effect of PRPs, were included.
  • One of the analyzed interventions had to be a PRP.
  • One of the analyzed interventions had to be a PRP.
  • Outcomes should be reported regarding disability, work participation or QoL.
  • To analyze dose, the number of contact hours should be reported.
  • Two reviewers independently selected titles, abstract and full text articles based on inclusion and exclusion criteria, data were extracted and risk of bias was assessed.
  • Effect sizes (ES) were calculated for each intervention and influence of dose variables was analyzed by a mixed model analysis.

Results

  • Eighteen studies were identified, reporting a wide variety of dose variables and contents of PRPs.
  • Analyses showed that evaluation moment, number of disciplines, type of intervention, duration of intervention in weeks, percentage of women and age, influence the outcomes of PRPs.
  • The independent effect of dose variables could not be distinguished from content because these variables were strongly associated.

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