Abstract: We included a total of nine RCTs (981 participants) in this review. Five studies were conducted in Europe and four in North America. Sample sizes ranged from 33 to 351. The mean age across trials ranged between 32.0 and 43.7 years. All included studies were judged as having high risk of performance bias and high risk of detection bias due to lack of blinding, and four of the nine studies suffered from at least one additional source of possible bias. In MBR compared to usual care for subacute LBP, individuals receiving MBR had less pain (four studies with 336 participants; SMD -0.46, 95% CI -0.70 to -0.21, moderate-quality of evidence due to risk of bias) and less disability (three studies with 240 participants; SMD -0.44, 95% CI -0.87 to -0.01, low-quality of evidence due to risk of bias and inconsistency), as well as increased likelihood of return-to-work (three studies with 170 participants; OR 3.19, 95% CI 1.46 to 6.98, very low-quality of evidence due to serious risk of bias and imprecision) and fewer sick leave days (two studies with 210 participants; SMD -0.38 95% CI -0.66 to -0.10, low-quality of evidence due to risk of bias and imprecision) at 12-month follow-up. The effect sizes for pain and disability were low in terms of clinical meaningfulness, whereas effects for work-related outcomes were in the moderate range. However, when comparing MBR to other treatments (i.e. brief intervention with features from a light mobilization program and a graded activity program, functional restoration, brief clinical intervention including education and advice on exercise, and psychological counselling), we found no differences between the groups in terms of pain (two studies with 336 participants; SMD -0.14, 95% CI -0.36 to 0.07, low-quality evidence due to imprecision and risk of bias), functional disability (two studies with 345 participants; SMD -0.03, 95% CI -0.24 to 0.18, low-quality evidence due to imprecision and risk of bias), and time away from work (two studies with 158 participants; SMD -0.25 95% CI -0.98 to 0.47, very low-quality evidence due to serious imprecision, inconsistency and risk of bias). Return-to-work was not reported in any of the studies. Although we looked for adverse events in both comparisons, none of the included studies reported this outcome. On average, people with subacute LBP who receive MBR will do better than if they receive usual care, but it is not clear whether they do better than people who receive some other type of treatment. However, the available research provides mainly low to very low-quality evidence, thus additional high-quality trials are needed before we can describe the value of MBP for clinical practice.

Plain-language summary: The search is current to July of 2016. Five studies were conducted in Europe and four in North America. Sample sizes ranged from 33 to 351. The mean age across trials ranged between 32.0 and 43.7 years. The majority of studies included mixed samples of male and female participants. The authors had no concerns about funding sources of any included studies. Overall, we found that multidisciplinary treatments may be better than usual care for people with LBP for a duration of six to 12 weeks. Individuals receiving multidisciplinary treatment had less pain, less disability, increased likelihood of return-to-work and fewer sick leave days at 12-month follow-up. However, when comparing multidisciplinary treatments to other treatments (e.g. brief clinical intervention including education and advice on exercise), we found that multidisciplinary treatments may be no better than other treatments. Although we examined adverse events as a secondary outcome, none of the included studies reported this outcome. The quality of the evidence for this review was generally low to very low. This was mainly due to small sample sizes and other study limitations. Moreover, we grouped together studies with differing interventions and comparisons. For example, some of the multidisciplinary interventions were quite intense (e.g. > 30 hours of treatment), whereas others were designed to be brief (e.g. < three hours). This variability across studies makes it more challenging to interpret the findings. In sum, there is a need for additional, large, high-quality randomised controlled trials before we can make definitive recommendations for clinical practice.