Effectiveness of multidisciplinary programmes for clinical pain conditions: An umbrella review
Elena Dragioti, Evangelos Evangelou, Britt Larsson, Björn Gerdle
Pain and Rehabilitation Centre, and Department of Medical and Health Sciences, Linköping University, SE-581 85 Linköping, Sweden. E-mail: firstname.lastname@example.org
Objective: To evaluate the strength of the evidence for multimodal/multidisciplinary rehabilitation programmes (MMRPs) for common pain outcomes.
Data sources: PubMed, PsychInfo, PEDro and Cochrane Library were searched from inception to August 2017.
Study selection: Meta-analyses of randomized controlled trials or controlled clinical trials and qualitative systematic reviews of randomized controlled trials and non-randomized controlled trials were considered eligible.
Data extraction: Two independent reviewers abstracted data and evaluated the methodological quality of the reviews. The strength of the evidence was graded using several criteria.
Data synthesis: Twelve meta-analyses, including 134 associations, and 24 qualitative systematic reviews
were selected. None of the associations in meta-analyses and qualitative systematic reviews were supported by either strong or highly suggestive evidence. In meta-analyses, only 8 (6%) associations that were significant at p-value ≤ 0.05 were supported by suggestive evidence, whereas 44 (33%) associations were supported by weak evidence. Moderate evidence was found only in 4 (17%) qualitative systematic reviews, while 14 (58%) qualitative systematic reviews had limited evidence.
Conclusion: There is no evidence that MMRPs are effective for prevalent clinical pain conditions. The majority of the evidence remains ambiguous and susceptible to biases due to the small sample size of participants and the limited number of studies included.
This study evaluated the published literature regarding multimodal/multidisciplinary rehabilitation programmes (MMRPs) for pain outcomes. The study reviewed the evidence on a large scale, examining 134 associations derived from 12 meta-analyses (including 462 primary studies) and 24 qualitative systematic reviews (including 243 primary studies). The results suggest that there is a lack of robust evidence about the effectiveness of the programmes investigated; most of the published studies displayed uncertainty in effect sizes due to large heterogeneity, small sample sizes, evidence of small-study effects, excess of significant findings, or any combination of the above. Some weak evidence, especially for short-term outcomes, may be genuine, but no firm conclusions can be drawn. This study highlights the necessity for larger, better-conducted, randomized controlled trials of the effectiveness of MMRP, with a standardized formula of treatment modalities, outcome measures, pain population, pain assessments, and length of treatments.
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