Study design: A systematic review.
Objective: To determine predictors of outcome of multidisciplinary rehabilitation-or back school treatment for patients with chronic low back pain.
Summary of background data: Numerous reviews have been performed to gain insight into which patients benefit from which treatment. However, no review has systematically focused on predictors from multiple domains (i.e., sociodemographic, physical, and psychological), or on treatment outcome measured as activity limitation or participation restriction.
Methods: Studies were found by searching medical and psychological databases, and screening references. Two reviewers independently assessed the methodological quality using standard criteria. Studies were only included if they met a predefined level of internal validity. A qualitative analysis was performed.
Results: Heterogeneity among studies in patient characteristics, predictors, treatment, and outcomes limited evidence. All reviewed studies were descriptive or exploratory in nature. Consistent evidence was found for the predictive value of pain intensity (more pain--> worse outcome), several work-related parameters (e.g., high satisfaction--> better outcome), and coping style (less active coping--> better outcome). Other sociodemographic and physical variables consistently lacked predictive value. No consistent evidence was found for other psychological variables.
Conclusions: It is impossible to define a generic set of predictors of outcome of multidisciplinary rehabilitation and back schools for patients with chronic low back pain because the reviewed studies were descriptive or exploratory in nature, and most predictors were only studied once. Nevertheless, for several predictors, consistent evidence was found. Large confirmatory studies are needed to test the value of these predictors.