Graded activity proves promising for low back pain sufferers

Non-specific low back pain is a common cause of disability and absence from work in the Western world. One promising strategy for workers with prolonged non-specific low back pain is active rehabilitation directed toward return to normal activity and work. A recent randomized, controlled trial has found that graded activity for low back pain sufferers is more effective than usual care in reducing the number of sick days from work.

Low back pain is a common biopsychosocial problem that causes significant disability and absence from work. In order to reduce the socioeconomic burden, interventions that promote safe and rapid return to work in an occupational health care setting are needed. One such strategy is graded activity interventions with physical exercise, application of operant-conditioning behavioural principals, and promotion of improved functioning.In a study published in the most recent edition of the “Annals of Internal Medicine,” a single-blind, randomized, controlled trial was conducted to determine the effectiveness of a behaviour-oriented graded activity program compared with usual care.The trial involved 134 workers who were absent from work because of low back pain. These subjects were randomly assigned to either graded activity (n=67) or usual care (n=67). The graded activity consisted of biweekly 1-hour exercise sessions with physiotherapists who emphasized operant-conditioning principles.The study results showed that over the 6months of follow-up, participants in the graded activity program missed 58days of work, while participants receiving usual care missed 87days. Interestingly, graded activity did not affect return to work until more than 50days after randomization. This may relate to the time involved in the intervention as participants may be less inclined to return to work during active treatment periods.For the patients randomized to receive graded activity, there was no statistically significant effect on functional status and pain when compared with those patients receiving usual care.The study concludes that a behaviour-oriented graded activity program returns participants with low back pain to work more often than does usual care. (Source: Annals of Internal Medicine 2004;140:77-84. Reviewed by B.Ricciardo)