Effectiveness of multidisciplinary biopsychosocial rehabilitation including workplace interventions for employees on sick leave due to low back pain: A systematic review

Background Effective management of low back pain requires a biopsychosocial approach, integrating physical, psychological, social, and occupational elements. Although moderate evidence supports multidisciplinary biopsychosocial rehabilitation and workplace interventions individually, the impact of combining these approaches for employees on sick leave due to low back pain remains unexplored. Objective This systematic review investigated the effectiveness of biopsychosocial rehabilitation including workplace interventions for employees on sick leave due to low back pain. Methods Structured literature search were conducted in MEDLINE, EMBASE, CINAHL, PEDro, PsycINFO and supplemented with grey literature. Eligible studies were randomized or non-randomized controlled studies involving employees on partial or full sick leave due to non-specific low back pain in subacute or persistent phases. Two reviewers independently performed screening, data extraction and risk-of-bias assessment. Interventions were described using the TIDieR checklist, and certainty of evidence was graded according to GRADE. Results Four publications representing three randomized controlled trials with 346 employees included. Evidence quality was low to very low for pain, return to work, and sick leave, but moderate for improvement of disability at 12 months follow-up. Conclusion Limited available evidence suggests that incorporating workplace interventions into multidisciplinary biopsychosocial rehabilitation may improve long-term disability for employees on sick leave due to low back pain. However, evidence for effects on pain, return to work and sick leave remains low or very low. This review identifies critical gaps in existing interventions and provides practice-based foundation, underscoring the need for further research to optimize rehabilitation for individuals with low back pain.