INTRODUCTION: Neck pain is one of the most common musculoskeletal disorders and it implicates several economical and social consequences. The efficacy of the education strategies of Cognitive Behavioural Therapy (CBT) has not been clearly determined yet. This systematic review aimed at finding the evidence of the efficacy of this therapeutic method in non-specific neck pain. METHODS: Bibliographic research was carried out from March 17th, 2008 to September 30th, 2009. The detected studies were examined and classified according to specific inclusion and exclusion criteria. Controlled trials concerning the effectiveness of CBT versus conventional trreatments were evaluated by means of JADAD Scale and PEDro Scale. RESULTS: Fifty-eight studies were found, eight of which (two reviews and six clinical trials) met the inclusion and exclusion criteria. Clinical trials quality was good in three studies, but scarce in the other three. The findings of included trials did not show significant differences between conventional and multidisciplinary therapy with respect to neck pain. The two evaluated systematic reviews confirmed this statement. CONCLUSION: This systematic review does not allow to assert that CBT leads to better results than conventional therapies. As reliable results lack, specific clinical trials are needed in order to study further CBT techniques specifically with regard to neck pain.
BACKGROUND: Multidisciplinary biopsychosocial rehabilitation programs for neck and shoulder pain require substantial staff and financial resources. Despite questionable scientific evidence of their effectiveness, they are widely used.
Neck and shoulder complaints are common among working age adults and they are often associated with physical work load and stress. Pain in the neck and shoulder area cause biopsychosocial difficulties for the patient, especially if disability due to pain is prolonged. To help patients with biopsychosocial problems, or to prevent their development, multidisciplinary biopsychosocial programs are used for rehabilitation for patients with neck and shoulder pain. Nevertheless, multidisciplinary treatment programmes are often laborious and rather long processes and require good collaboration between the patient, the rehabilitation team and the work place.
OBJECTIVES: The objective of this systematic review was to determine the effectiveness of multidisciplinary biopsychosocial rehabilitation for neck and shoulder pain among working age adults.
SEARCH STRATEGY: The reviewed studies for this review were electronically identified from MEDLINE, EMBASE, PsycLIT, CENTRAL, Medic, the Science Citation Index, reference checking and consulting experts in the rehabilitation field. The original search was planned and performed for more broad area of musculoskeletal disorders. Trials on neck and shoulder pain were separated afterwards. The literature search was updated in November 2002 by electronically searching MEDLINE and EMBASE.
SELECTION CRITERIA: From all references identified in our original search, we selected randomized controlled trials (RCTs) and non-randomized controlled clinical trials (CCTs). Trials had to assess the effectiveness of biopsychosocial rehabilitation for working age adults suffering from neck and shoulder pain. The rehabilitation program was required to be multidisciplinary, i.e., it had to consist of a physician's consultation plus either a psychological, social or vocational intervention, or a combination of these.
DATA COLLECTION AND ANALYSIS: Four authors blinded to journal and author selected the trials that met the specified inclusion criteria. Two experts in the field of rehabilitation evaluated the clinical relevance and applicability of the findings of the selected studies for actual clinical use. Two other authors blinded to journal and author extracted the data and assessed the main results and the methodological quality of the studies, using standardized forms. Finally, a qualitative analysis was performed to evaluate the level of scientific evidence for the effectiveness of multidisciplinary biopsychosocial rehabilitation.
MAIN RESULTS: After screening 1808 abstracts, and the references of 65 reviews, we found only two relevant studies that satisfied our criteria. No more studies were found for this update. One of the studies was considered to be a methodologically low quality RCT and the other one was a methodologically low quality CCT. The clinical relevance of included studies was satisfactory. There was limited scientific evidence for the effectiveness of multidisciplinary biopsychosocial rehabilitation for neck and shoulder pain.
AUTHORS' CONCLUSIONS: We conclude that there appears to be little scientific evidence for the effectiveness of multidisciplinary biopsychosocial rehabilitation compared with other rehabilitation facilities for neck and shoulder pain. Multidisciplinary rehabilitation is a commonly used intervention for chronic neck and shoulder complaints, therefore we see an urgent need for high quality trials in this field.
Neck pain is one of the most common musculoskeletal disorders and it implicates several economical and social consequences. The efficacy of the education strategies of Cognitive Behavioural Therapy (CBT) has not been clearly determined yet. This systematic review aimed at finding the evidence of the efficacy of this therapeutic method in non-specific neck pain.
METHODS:
Bibliographic research was carried out from March 17th, 2008 to September 30th, 2009. The detected studies were examined and classified according to specific inclusion and exclusion criteria. Controlled trials concerning the effectiveness of CBT versus conventional trreatments were evaluated by means of JADAD Scale and PEDro Scale.
RESULTS:
Fifty-eight studies were found, eight of which (two reviews and six clinical trials) met the inclusion and exclusion criteria. Clinical trials quality was good in three studies, but scarce in the other three. The findings of included trials did not show significant differences between conventional and multidisciplinary therapy with respect to neck pain. The two evaluated systematic reviews confirmed this statement.
CONCLUSION:
This systematic review does not allow to assert that CBT leads to better results than conventional therapies. As reliable results lack, specific clinical trials are needed in order to study further CBT techniques specifically with regard to neck pain.
Systematic Review Question»Systematic review of interventions
