Appendix 1

Medline search strategy

1. randomized controlled trial.pt.

2. controlled clinical trial.pt.

3. randomized.ab.

4. placebo.ab,ti.

5. drug therapy.fs.

6. randomly.ab,ti.

7. trial.ab,ti.

8. groups.ab,ti.

9. or/1-8

10. (animals not (humans and animals)).sh.

11. 9 not 10

12. multidisciplinar$.mp.

13. interdisciplinar$.mp.

14. multiprofessional$.mp.

15. multimodal$.mp.

16. exp Patient Care Team/

17. exp Patient Care Management/

18. exp Patient Education/

19. exp Social Support/

20. exp Social Environment/

21. exp Pain Clinics/

22. (pain clinic$ or pain center$ or pain service$ or pain relief unit$ or pain centr$).mp.

[mp=title, abstract, original title, name of substance word, subject heading word, keyword

1
heading word, protocol supplementary concept word, rare disease supplementary concept

word, unique identifier]

23. exp Social Work/

24. exp Occupational Therapy/

25. exp Rehabilitation/ or exp Rehabilitation Centers/ or exp Rehabilitation, Vocational/

26. exp Treatment Outcome/

27. exp Behavior Therapy/

28. "Recovery of Function"/

29. functional restoration.mp.

30. *Pain/rh

31. or/12-30

32. exp Arthritis, Rheumatoid/

33. exp Neoplasms/

34. exp Musculoskeletal Diseases/cn, su [Congenital, Surgery]

35. exp Central Nervous System/

36. exp Central Nervous System Diseases/

37. exp Dentistry/

38. exp Tooth Diseases/

39. or/32-38

40. dorsalgia.ti,ab.

41. exp Back Pain/

42. backache.ti,ab.

43. (lumbar adj pain).ti,ab.

44. coccyx.ti,ab.

45. coccydynia.ti,ab.

2
46. sciatica.ti,ab.

47. sciatica/

48. spondylosis.ti,ab.

49. lumbago.ti,ab.

50. exp low back pain/

51. or/40-50

52. 51 and 11 and 31

53. 52 not 39

54. limit 53 to ed=20130201-20141231

55. limit 53 to ed=20130201-20140131

56. limit 53 to yr="2013 -Current"

57. 55 or 56

3
Appendix 2. Table: Study characteristics

Study Participants MBR Comparator 1 Comparator 2 Compari

son

Abbassi 2013 Iran. Adults referred to medical P-MPMP. Group Rx (6/group) 7x weekly sessions 2hours SA-MPMP. Same as MBR but Usual medical care MBR

centre pain clinic. LBP >6/12, each session, + 1 session with doctor, + 1 session with spouse involved in sessions N = 11 Usual

married physiotherapist. Light mobilisation, coping skills training, N = 10

88% female, mean age 45, education regarding anatomy, physiology, medication,

median pain duration 74 months exercise session

N = 12

Alaranta 1994 Finnish workers on social 3 week daily HEP then 3 week inpatient program (42 3/52 inpatient program: passive Phys

Insurance. LBP >6 months, hours/week). Program: strength training, aerobic training, physio (electrotherapies,

fewer than 2 back surgeries, no relaxation, stretching, CBT, discussion groups massage, traction), muscle

contraindications to exercise. N = 152 training, pool exercises, back

56% female; mean age 40.5, school

mean pain duration NR N = 141

Basler 1997 Germany. Adult referrals to pain 1 session/week for 12 weeks, 150min each session, group Usual care: Pain medication, Usual

treatment centres. Diagnosis of format (5-8/group), plus homework assignments. CBT (pain nerve blocks, TENS, physio

LBP, no previous CBT education, relaxation, modifying beliefs, pleasant activity N = 40

75.6% female, mean age 49.3, scheduling), posture training, strengthening, stretching + Pain

mean pain duration 10.8 years medication, nerve blocks, TENS, physio

N = 36

4
Bendix ‘A’ Denmark. Adults referred to 39 hours/week for 3 weeks inpatient, in groups (7/group), Usual care in Denmark, free to Usual

(1996/1998) back centre. Disabling LBP >6 plus 1x 6 hour session/week for 3 weeks). Aerobic ex., seek any treatment

months, threatened job situation strength, stretching, simulated work tasks, biofeedback, pan N = 49

70.2% female, median age 40, coping, goal setting, cognitive appraisal, relaxation, job

mean pain duration NR seeking skills, recreation, ball games, running, swimming

N = 45

Bendix ‘B’ Denmark. Adults referred to 39 hours/week for 3 weeks inpatient, in groups (7/group), 2x 2 hour sessions/week for 6/52 2x 2 hour Phys

(1995/1998) back centre. Disabling LBP >6 plus 1x 6 hour session/week for 3 weeks). Aerobic ex., (total24 hr), in groups (7-8/group). sessions/week for MBR

months, threatened job situation strength, stretching, simulated work tasks, biofeedback, pan Aerobics, progressive 6weeks, in groups

75.4% female, median age 42, coping, goal setting, cognitive appraisal, relaxation, job strengthening, back school (7-8/group).

mean pain duration NR seeking skills, recreation, ball games, running, swimming N = 31 Psychological pain

N = 40 management, warm-

up, progressive

strengthening

N = 35

Bendix ‘C’ Denmark. Adults referred to 39 hours/week for 3 week inpatient, in groups (7/group), plus 1,5 hour sessions, 3x/week for Phys

(2000) back centre. Disabling LBP >6 1x 6 hour session/week for 3 weeks). Aerobic ex., strength, 8/52 (total 28 hr); aerobic and

months, threatened job situation stretching, simulated work tasks, biofeedback, pan coping, strengthening exercises

65.4% female, median age 41, goal setting, cognitive appraisal, relaxation, job seeking skills, N = 68

mean pain duration NR recreation, ball games, running, swimming

N = 59

5
Coole (2013) UK. Patients referred to group Maximum of 10 weeks of 2-3 hours/week. Group education Maximum of 10 weeks of 2-3 Phys

rehabilitation with LBP >6 and physical activity program with CBT approach. Possible hours/week. Group education and

weeks, employed, concerned referral to psychologist. Individual work support, max. 8 face- physical activity program with

about work ability. to-face contacts of 90min; workplace assessment, barrier to CBT approach. Possible referral

52.9% female, mean age 44, LBP managements, communication with employer, work- to psychologist.

mean pain duration 88 months. focused interventions. N = 28

N = 23

Fairbank UK. Adults in surgical 5 days/week for 3 weeks plus 1 follow-up session. Stretching, Spinal stabilisation surgery Surg

(2005) departments. LBP >12 months, strengthening, stabilisation, cardiovascular endurance, N = 176

surgeon unsure if surgery or hydrotherapy. CBT approach; pacing, addressing unhelpful

rehabilitation more suitable. beliefs and fears

50.7% female, mean age NR, N = 173

mean pain duration 8 years

Harkapaa Finland. Blue collar workers 3 week inpatient program, sessions in groups (6-8/group). 2x session/week for 2 months (15 Written and oral Phys

(1989) recruited by mail. Chronic or Swedish back school, back exercises, relaxation exercises, sessions). Swedish back school, instructions; back MBR

recurrent LBP >2 years that heat/electrotherapy, discussion groups on coping and back back exercises, relaxation exercises and

causes sick leave, physically care. HEP stretching and stretching + massage and exercises, heat/electrotherapy, ergonomics. No

strenuous job. strengthening and physical exercises. 2nd part (1.5 yr later), discussion groups on coping, and structured treatment

37% female, mean age 44.9, 2 week inpatient, rehearse and refresh back and self-care back care. HEP stretching and N = 153

mean pain duration NR skills strength. 2nd part (1.5 yr later), 8

N = 156 sessions inpatient, rehearse and

6
 refresh back and self-care skills

N = 150

Hellum (2011) Norway. Adults from local Outpatient treatment in groups, 60 hours over 2-5 weeks. Surgical disc replacement with Surg

hospitals and primary care. LBP Education (anatomy, psychology, imaging, coping, artificial disc (ProDisc)

>12 months, unsuccessful medication, family, work and social life), daily exercises N = 86

physio or chiro, degenerative (endurance, strength, coordination), challenging beliefs.

disc changes, Oswestry >30% Follow-up consults 6weeks, 3+6+12 months

50.8% female, mean age 41, N = 87

mean pain duration 6.8 years

Henchoz Switzerland. Adults from a 3 weeks of 5 days/week, 5-7 hours/day, in groups (5/group) 18 physio sessions (45min) over 9 Phys

(2010) hospital rheumatology outpatient and individual Intensive physical and ergonomic training, weeks. Active exercise and

clinic. LBP >6 weeks psychological pain management, back school, social and passive modalities to manage

32% female, mean age 39.8, work-related education, tailored medication programme pain, improve mobility and

mean pain duration NR N = 56 increase activity level

N = 53

Joussett France. Adult referrals to a 5 weeks of 6 hour/day, 5 day/week in groups (6-8/group). 5 week 3x 1 hour sessions/week, Phys

(2004) hospital multidisciplinary LBP Exercise with physio; warm-up, stretching, flexibility, aerobic plus HEP; 2x 50min/week. Active

clinic. LBP not relieved by (walking, running, cycling), strength, muscular endurance, exercise directed by physio,

conventional Rx, threatened job coordination exercises. OT; work simulations. Psychologist; flexibility, stretching, strength,

situation counselling proprioception exercises,

33% female, mean age 40.3, N = 43 endurance training, HEP; jogging,

7
 mean pan duration NR swimming, stretching

N = 41

Jackel (1990) Germany. Referrals to a 4-6 weeks, physio 2x/day in pool, 1x/day in gym. Education: Waiting list Wait list

Rehabilitation hospital anatomy, lifting instructions. 8-10x mudbaths, 8x massage, N = 38

62% female, mean age 48.7, 8x electro therapy. Psychology: pain beliefs, coping,

mean pain duration 12.8 years depression, impact of pain on life

N = 33

Kaapa (2006) Finland. Female workers 2 weeks of 5 days/week, 6 hours/day, then 5 weeks of 2x 4 10x 1 hour sessions over 6-8 Phys

referred to two Occupational hours/week, 2/52 HEP. CBT stress management, relaxation, weeks. Passive treatment

Health centres. Daily or nearly Swedish Back School (education), aerobic fitness, flexibility, (massage, electro modalities,

daily LBP for the past 1 year coordination, strengthening, progressive relaxation traction, mobilisation), active

100% female, mean age 46.3, N = 59 (stretching, mobility, coordination

mean pain duration 1.3 years exercises), general increase in

physical activity recommended

(walking, swimming, daily

activities)

N = 60

Kole Snijders Netherlands. Adults referred to Individual and group, 5 week inpatient plus 3 week Individual and group, 5 week Wait list Wait list

(1999) Rehabilitation Centre by GP or outpatient. Operant behavioural treatment, quota-based inpatient plus 3 week outpatient. N = 31 MBR

specialist. LBP >6 months, activities, standing and sitting tolerance, daily activity Operant behavioural treatment,

discrepancy b/w subjective schedule for home, spouse group training (education and quota-based activities, standing

8
 complaints and objective discussion). Cognitive coping skills, increasing pain control and sitting tolerance, daily activity

findings and self-efficacy, education, biofeedback schedule for home, spouse group

64% female, mean age 39.8, N = 59 training (education and

mean pain duration 10 years discussion). Group discussion

(attention control for cognitive

coping training)

N = 58

Kool Switzerland. Adult patients 6 days/week for 3 weeks, 4 hours/day. Time contingent: work 6 days/week for 3 weeks, 2,5 Phys

(2005/2007) referred to work rehabilitation simulation, endurance training, strengthening, aerobic hours/day. All activity was pain-

centre training. Counselling, education, self-efficacy, analgesic contingent: Passive and active

21.3% female, mean age 42.1, medication mobilisation, stretching, strength,

mean pain duration NR N = 87 back school (education), heat,

electrotherapy, massage,

progressive relaxation, analgesic

medication

N = 87

Lambeek Netherlands. Adults from Up to 12 weeks (26 sessions). CBT-based graded activity, Usual care in Netherlands as Usual

(2010) outpatient clinic; orthopaedic, education, ergonomics, workplace intervention (including directed by medical specialist

neurology, rheumatology, employer) N = 68

neurosurgery. N = 66

42% female, mean age 46.2,

9
 mean pain duration NR

Leeuw (2008) Netherlands, referred by Exposure: 16x 1hr sessions, 2/week. Information re: Graded Activity: 26x 1hr sessions, MBR

physicians from outpatient diagnosis, imaging, continued active approach, treatment 2/week. Information re: diagnosis,

rehabilitation centres or rationale. Establishment of hierarchy of feared activities, imaging, continued active

responded to advertisements. explanation of fear avoidance model, gradual, systematic approach, treatment rationale.

48% female, mean age 45.3, exposure to feared activities. Behavioural experiments to test Identification of functional

mean pain duration 9 years consequences of engagement in feared activities treatment goals, quota-based

N = 42 gradual increase in performance

of functional activities

N = 43

Linton (2005) Sweden. Workers referred to 6 week, 1x/week, 2 hour/session plus homework. Physical 6 week, 1x/week, 2 hour/session Usual care, plus Usual

primary care facilities with back Therapy (unconstrained volume); information on prevention, plus homework, CBT (6- minimal intervention MBR

or neck pain at risk of developing cause of LBP, activity advice, functional training, 10/group); pain education, (1 session),

long-term disability. personalised programs, CBT (6-10/group); pain education, problem solving, coping skills, education, activity

83% female, mean age 49, problem solving, coping skills, increase in function, graded increase in function, graded advice, booklet,

mean pain duration NR activity, stress management, relaxation, dealing with activity, stress management, patients free to seek

exacerbations. Minimal intervention (1 session), education, relaxation, dealing with any medical care

activity advice, booklet, patients free to seek any medical exacerbations plus minimal N = 47

care intervention (1 session).

N = 69 N = 69

Lukinmaa Finland. Adults referred to a 5 days inpatient. Treatment according to biopsychosocial Orthopaedic outpatient treatment. Usual

10
(1989) regional hospital. LBP model Treatment according to

52.7% female, mean age 43.6, N = 102 biomedical model

mean pain duration 15.3 months N = 101

Mangels Germany. Patients in an 4 week inpatient intervention, individual or group. Analgesic 4 w eek inpatient intervention, 3 weeks mostly MBR

(2009) Orthopaedic rehabilitation medication, aerobic exercises, coordination exercise, individual or group. Analgesics, physical/orthopaedic Phys

hospital. Diagnosed with ergonomic advice, ADL physical capacity training, back aerobic exercises, coordination treatment; active

musculoskeletal disorders (ICD school (education), massage, electrotherapy, hydrotherapy, exercise, ergonomic advice, ADL physiotherapy,

10) thermotherapy, nutrition and social advice. CBT-based physical capacity training, back passive modalities

77.7% female, mean age 48.8, psychological pain management (11/group), BPS model school (education), massage, and occupational

mean pain duration NR education, pain coping, progressive muscle relaxation. 7 electrotherapy, hydrotherapy, therapy

booster sessions on telephone over 12 weeks to reinforce thermotherapy, nutrition, social N = 131

inpatient topics, problem-solving, goal setting, relaxation, advice. CBT-based psychological

coping pain management (11/group),

N = 119 BPS model education, pain

coping, progressive relaxation

N = 113

Meng (2011) Germany. Patients in an 7x 55 minute session, (<16/group). Back school, education, 6x 55 minute session, in groups MBR

Orthopaedic rehabilitation (anatomy, epidemiology, risk factors, therapy), BPS model, (<60/group). Back school, posture

hospital. With musculoskeletal pain education, fear avoidance, coping, social aspects, and movement exercises, pain

disorder (ICD 10) muscle training and stabilisation exercises, recommendation education, coping, education

64% female, mean age 49, for increased physical activity N = 185

11
 mean pain duration NR N = 197

Mitchell (1994) Canada. Workers on Worker's 8 week, 7 hours/day, 5 days/week, group sessions (10- Usual care, variable including; Usual

Compensation Board list. Injured 12/group). Physical exercise; mobility, strength, flexibility, physiotherapy, medication,

workers with inappropriate endurance, stretching, ice, circuit training, work simulation manipulation, acupuncture, work

illness behaviours who has not exercises (lifting). Behavioural and cognitive treatment, hardening, back schools, active

recovered after 3 months. correction of unhelpful beliefs, education, relaxation, exercise

28.5% female, mean age NR, biofeedback, personal responsibility N = 271

mean pain duration NR N = 271

Moix (2003) Spain. Adults in a hospital pain 11 sessions/week, about 60 min/session. Interdisciplinary Usual care: pain control through Usual

clinic with LBP/radiculopathy or program: psychology: (3x group and 3x individual sessions: the treatment of the

cervical pain. relaxation, visualization, organization of the daily life, anaesthesiology team

53.3% female, mean of age increasing pleasure activities, sleep advice, assertiveness N = 15

54.3, mean duration NR and emotional expression); physiotherapy: (3 sessions:

postural advice and physical activities); anaesthetics: (1

session: pain mechanisms and analgesic explanation);

orthopaedic surgeons: (1 session: pain organic causes); and

social worker: (1 session: resources to carry out activities

and sick leave explanation).

N = 15

Monticone Italy. Adults referred to a 5 weeks plus 12 months reinforcement. 5x /week 60min Physical program: active and Phys

(2013) rehabilitation centre. LBP>3/12. individual CBT sessions, then 1x session/month for 12 passive mobilisations, stretching,

12
 57.8% female, mean age 49.3, months. Fear avoidance beliefs, catastrophising, strength, postural/motor control

mean pain duration 25.8 months inappropriate beliefs, negative thoughts, transferring exercises. Up to 10x (2x/week for

attention, graded exposure, motivation, goal-setting. Physical 5 weeks) plus home exercise

program: active and passive mobilisations, stretching, program

strength, postural/motor control exercises. Up to 10x N = 45

(2x/week for 5 weeks) plus home exercise program

N = 45

Morone (2011) Italy. Adults referred to a 4 week, 10x 1 hour session (4-5/group). Education (anatomy, Usual care; Medical mostly Usual

rehabilitation centre. LBP>3/12. pain, stress management, workplace, sport activities, pharmacological

64.3% female, mean age 60.2, posture), Exercise prescription (ergonomics, ADLs, HEP), N = 29

mean pain duration NR stretching, strengthening, core stability

N = 44

Morone (2012) Italy. Adults referred to an 4 week, 10x 1 hour session (4-5/group). Education (anatomy, 4 weeks, 3x /week, proprioceptive Usual care; Medical Phys

academic hospital. LBP>3/12. pain, stress management, workplace, sport activities, and perception tasks while lying mostly Usual

72% female, mean age 55.4 posture), Exercise prescription (ergonomics, ADLs, HEP), on deformable latex cones pharmacological

mean pain duration NR stretching, strengthening, core stability N = 25

N = 25

Nicholas Australia. Adults referred from 5 weeks, 2x /week, 2 hour session. Education (anatomy, 5 weeks, 2x /week, 2 hour 5 weeks, 2x /week, Phys

(1991) pain clinic, GPs or specialist. back care, lifting, medication, diet/weight), strengthening, session. Education (anatomy, 2 hour session. MBR

LBP >6 months mobility, hydrotherapy, HEP. Behavioural treatment; goal- back care, lifting, medication, Education (anatomy,

51.7% female, mean age 41.2, setting (social, home, work) and advice, medication diet/weight), strengthening, back care, lifting,

13
 mean pain duration 7 years reduction, pacing, given positive reinforcement [+/- mobility, hydrotherapy, HEP. medication,

Relaxation treatment; progressive muscle relaxation] Cognitive treatment; chronic pain diet/weight),

N = 10 / 9 education, coping, attention, strength, mobility,

challenging and altering unhelpful hydrotherapy, HEP.

cognitions, distraction techniques. [+/- Attention

[+/- Relaxation treatment; control; group

progressive muscle relaxation] discussion, no

N = 10 / 8 advice or

information]

N = 10 / 11

Nicholas Australia. Adults referred from 5 weeks, 2x /week, 2 hour session. Education (anatomy, 5 weeks, 2x /week, 2 hour Phys

(1992) pain clinic, GPs or specialist. back care, lifting, medication, diet/weight), strengthening, session. Education (anatomy,

LBP >6 months mobility, hydrotherapy, HEP. CBT; chronic pain education, back care, lifting, medication,

45% female, mean age 43.7, coping, attentional processes, challenging and altering diet/weight), strength, mobility,

mean pain duration 5.5 years unhelpful cognitions, distraction techniques. Progressive hydrotherapy, HEP. Attention

muscle relaxation control; group discussion, no

N = 20 advice or information

N = 20

Roche- France. Adults referrals to a 5 weeks x 6 hour/day, 5 day/week in (6-8/group). 5 week 3x 1 hour sessions/week, Phys

LeBoucher hospital multidisciplinary LBP Physiotherapy; warm-up, stretching, flexibility, aerobic plus HEP. Active exercise;

(2007/2011) clinic. LBP >3 months, on sick exercises (walking, running, cycling), strengthening, flexibility, stretching, strength,

14
 leave or at risk of work disability muscular endurance, coordination exercises. OT; work proprioception, endurance, HEP;

35% female, mean age 39.8, simulations. Psychologist; counselling jogging, swimming, stretching

mean pain duration NR N = 68 N = 64

Schweikert Germany. Recruited from lists of 3 week inpatient program, small groups. Daily physio; 2x /day 3 week inpatient program, small Phys

(2006) a work insurer for referral to a exercises, massage, electrotherapies, education, advice groups. Daily physio; 2x /day

rehabilitation hospital. LBP >6 about risk factors, back care etc. CBT; coping, motivation, exercises, massage,

months. pain management, relaxation, distraction, cognitive electrotherapies, education, risk

46.7% female, mean age 17.1, reappraisal factors advice, back care

mean pain duration NR N = 200 N = 209

Skouen (2002) Norway. Employees on National 4 weeks x 6 hour/day, 5 days/week. CBT (group); fear Unspecified number of Usual care under MBR

Health Insurance list. Workers avoidance, coping strategies. Education; pain mechanisms, consultations (av. 3) with physio GP; usually involved Usual

sick-listed > 2 months in the last anatomy, exercise advice. Workplace interventions. Graded and sometimes nurse or pain medication,

year. exercise program; stretching, strengthening, mobility, psychologist if necessary. and referral to

43.5% female, mean age 43.6, coordination exercises, aerobic training. Relaxation, body Education; exercise, lifestyle, fear physio or chiro

mean pain duration NR awareness training. HEP at the end of the intervention avoidance, advice to reduce N = 86

N = 57 illness behaviours and anxiety.

HEP program and advice to stay

active and gradually increase

activity levels

N = 52

Smeets Netherlands. Adult patients 10 weeks. Active physical training (3x /week 2 hour); aerobic 10 weeks. Active physical training CBT; graded activity Phys

15
(2006/2008) referred by GPs and specialists training, strengthening, stretching. CBT ; graded activity (18 (3x/week 2 hour); aerobic training, (18 sessions), MBR

to 3 rehabilitation centres. LBP sessions), problem-solving (10x 90min), modification of strengthening, stretching. problem-solving Wait list

>3 months, RMDQ >3, able to dysfunctional beliefs, HEP increasing activity. N = 52 (10x 1 1/2 hr),

walk 100m. N = 55 modification of

41.6% female, mean age 47.2, dysfunctional

mean pain duration 4.7 years beliefs, HEP

increasing activity.

N = 55

Strand (2001) Norway. Adults sick-listed >2/12 4 weeks x 6 hour/day, 5 days/week. Physical treatment Usual care in the community, Usual

due to back pain. (strengthening, body awareness, aerobic fitness, relaxation), most had physiotherapy, 1/3 have

61% female, mean age 43.6, education, CBT (coping, responsibility for treatment, focus alternative interventions

mean pain duration 10 years away from pain), workplace intervention N = 36

N = 81

Streibelt Germany. Adults referred from 3 week inpatient program, 3-4 hours /day. Physical therapy, 3 week inpatient program, 3-4 Phys

(2009) work insurance provider. Limited exercises, massage, education, relaxation. Focus on work- hours /day. Physical therapy,

work ability. specific skills and functional capacity with operant exercises, massage, education,

16.7% female, mean age 45.8, behavioural approach. Coping skills relaxation

mean pain duration NR N = 109 N = 113

Tavafian Iran. Adult women LBP >3 4 days, 5 sessions, based on Back school. Education; Medical management, mostly Usual

(2008) months recruited from outpatient anatomy, physiology, pathology of LBP, self-care, health medication prescription

rheumatology clinics behaviours, biomechanics, lifestyle, prevention. Psychologist; (analgesics, muscle relaxants,

16
 100% female, mean age 42.9, coping skills, anger management, relaxation. Physiotherapist; NSAIDs, anti-depressants)

mean pain duration 9.1 months stretching, strength, posture, functional movement,HEP N = 52

N = 50

Tavafian Iran. Adult patients referred to 5x 2 hour sessions in one week (group), plus monthly Medical management, mostly Usual

(2011) rheumatology clinics in 3 booster sessions and telephone counselling. Education medication prescription

teaching hospitals, and 1 private (anatomy, risk factors, lifestyle advice, posture, diagnosis, (analgesics, muscle relaxants,

clinic with LBP >3 months pain education). Stretching, strength, relaxation exercises, NSAIDs, anti-depressants)

22% female, mean age 45.3, HEP. Psychologist; coping, stress, perceptions of control, N = 100

mean pain duration 6.8 years emotional reactions, problem solving, relaxation. CBT;

maladaptive cognitions, fear avoidance, activity participation,

adjustment to pain. Motivational counselling. Medication

(analgesics, muscle relaxants, NSAIDs, anti-depressants)

N = 97

Turner (1990) USA. Patients referred by 8 sessions, 1x/ week for 2hours, in groups of 5-10. 8 sessions, 1x/ week for 2hours, Wait list Phys

community physician or Behavioural: Education about pain behaviours (with spouse), in groups of 5-10. Exercise (10- N = 24 Wait list

responded to advertisement. communication training, goal-setting for behavioural 20min 5x /week HEP): gradually

LBP >6 months activities, group discussions, homework. Exercise (10-20min progressed walking/jogging on a

49% female, mean age 44, 5x /week HEP): gradually progressed walking/jogging on a quota system, warm-up and cool-

mean pain duration 12.9 years quota system, warm-up and cool-down stretches down stretches

N = 24 N = 25

Van den Hout Netherlands. Patients with work 19x half day sessions over 8 weeks (5/group). Graded 19x half day sessions over 8 MBR

17
(2003) absence >6 weeks due to LBP, activity; gradual increase in physical activities, including weeks (5/group). Graded activity;

referred by GP, occupational or work-specific tasks, as directed by OT included a work visit, gradual increase in physical

rehabilitation physician back education and lifting instructions, ADLs, leisure activities / work-specific tasks, as

33.7% female, mean age 40.5, activities, housework. Problem solving; CBT approach to directed by OT included a work

mean pain duration 1.6 years problem solving skills, training and application of skills to visit, back education and lifting

daily life, included homework assignments. Group education instructions, ADLs, leisure

sessions related to back and back pain. activities, housework. Group

N = 45 education sessions related to

back and back pain.

N = 39

Vollenbroek- Netherlands. Adults referred to a 9 hours/week for 7 weeks (8/group). Education; back pain, Usual care in the Netherlands Usual

Hutton (2004) multidisciplinary rehabilitation chronicity, interaction of reduced physical activity and pain. N = 84

program with LBP >6 months Physical training; aerobic training, swimming, physiotherapy.

and no surgery in past 3 months Occupational therapy

% female NR, mean age 39, N = 79

mean pain duration 5 years

Von Korff USA. Insured adults receiving 4x 90min sessions. Psychologist; identify fears, relationship Usual care in the community, Usual

(2005) primary care for LBP, >7/23 on b/w activity and pain, goal setting, relaxation, managing flare- usually included medication

RMDQ ups. Physio; discussed concerns and identify barriers to N = 121

62.5% female, mean age 49.8, increasing activity, stretches, exercises to achieve activity

mean pain duration NR goals, HEP. Self-management book

18
N = 119

19
Appendix 3. Funnel Plot

Funnel plot of comparison: MBR versus physical treatment. Disability long term.

20