Background and aims: Few studies have examined the association between the dosage of multimodal pain therapy (IMPT) and outcome effects. The aim of this study was to examine the influence of dosage of IMPT on pain, disability, return to work, quality of life, depression, and anxiety in randomized controlled trials (RCTs), using a systematic meta-epidemiological approach followed by meta-analysis.
Methods: Eligible studies were only RCTs of IMPT versus any type of control arm in patients with chronic low-back pain (CLBP). Effect sizes, in short length, in non-daily contact, and in low-intensity RCTs were compared with long length, daily contact, and high-intensity RCTs using random-effects models and a summary relative odds ratio (ROR) were calculated. Heterogeneity was quantified with the I2metric.
Results: A total of 47 RCTs was selected and analyzed. The summary RORs were not significant, indicating that the length, contact hours, and intensity of treatment did not have an overall effect on pain outcomes. Per outcome, only for pain and disability the RORs were significant demonstrating larger effects in RCTs with long length, non-daily contact, and low intensity of treatment. Large heterogeneity was also observed.
Conclusions: The dosage of IMPT was not associated with better effects on pain outcomes in patients with non-specific CLBP. A program with a duration greater than five weeks and with non-daily contact and low intensity may be more beneficial for pain and disability. The optimum dosage of IMPT is currently unknown.

A META-EPIDEMIOLOGICAL APPRAISAL OF MULTIDISCIPLINARY REHABILITATION DOSING FOR CHRONIC LOW BACK PAIN