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Development of a Multidisciplinary Stroke Program
Several gaps and no formal system existed for coordinating stroke-related care at the Durham VAMC until a team of dedicated health care providers...
It can be expensive, but multidisciplinary rehabilitation may be more cost-effective for treating chronic low back pain in the long-term, according to researchers from the University of Sydney in Australia; VU University Medical Centre in Amsterdam and Maastricht University Medical Centre, both in the Netherlands; and University of British Columbia in Vancouver, Canada. After analyzing 41 trials comparing a variety of biopsychosocial interventions with usual care and physical treatment, researchers found benefits in reduced pain and disability and a greater likelihood of returning to work (odds ratio 1.04, .73-1.47) that lasted beyond 1 year.
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The multidisciplinary approach involved a physical component and a psychological component and/or a social/work-targeted component. The interventions were of any intensity and rehabilitation approach and could be provided in inpatient or outpatient settings. The control interventions were classified as usual care, physical treatment, surgery, and waiting list.
The researchers found moderate-quality evidence that multidisciplinary rehabilitation programs are more effective than is usual care (95% confidence interval, .04-.37) for reducing pain and disability from chronic low back pain. They also found no difference between the effects of surgery compared with multidisciplinary treatment on pain (standardized mean difference [SMD] .72, 0.24-1.22); disability (SMD .49, 0.22-0.76); and work (SMD .67, 0.31-1.45). The researchers also noted that surgery comes with a greater risk of adverse events.
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The modest results should be weighed against the monetary costs and time commitments associated with multidisciplinary rehabilitation, the researchers caution. They suggest referring only those patients for whom low back pain has major physical and psychological effects.
Source
Kamper SJ, Apeldoorn AT, Chiarotto A, et al. BMJ. 2015;350:h444.
doi: 10.1136/bmj.h444.