Graded activity for workers with low back pain: Who benefits most and how does it work?

Staal, J. Bart, Hlobil, Hynek, Köke, Albère J. A., Twisk, Jos W. R., Smid, Tjabe and van Mechelen, Willem (2008) Graded activity for workers with low back pain: Who benefits most and how does it work?. Arthritis Care and Research, 59 5: 642-649. doi:10.1002/art.23570

Author Staal, J. Bart
Hlobil, Hynek
Köke, Albère J. A.
Twisk, Jos W. R.
Smid, Tjabe
van Mechelen, Willem
Title Graded activity for workers with low back pain: Who benefits most and how does it work?
Journal name Arthritis Care and Research   Check publisher's open access policy
ISSN 2151-464X
Publication date 2008-05-15
Sub-type Article (original research)
DOI 10.1002/art.23570
Volume 59
Issue 5
Start page 642
End page 649
Total pages 8
Place of publication New York, NY, United States
Publisher John Wiley & Sons
Language eng
Subject 1103 Clinical Sciences
1110 Nursing
Formatted abstract
To identify subgroups of workers absent from work due to low back pain who are more or less likely to return to work earlier as a result of a graded activity intervention, and to investigate whether this intervention is effective in reducing pain-related fears and if so, whether these reductions in pain-related fears mediate return to work.

A subgroup analysis was conducted on data from a previous randomized controlled trial of 134 Dutch airline workers, which found that a behaviorally-oriented graded activity intervention was more effective than usual care in stimulating return to work. The subgroup analyses added interaction terms to a Cox regression model that described the relationship between treatment allocation and return to work over 12 months of followup. Furthermore, we studied the effects of graded activity on pain-related fears and added variables indicating a reduction in pain-related fears to the model in order to investigate their influence on return to work.

Statistically significant interactions were found for disability, fear-avoidance beliefs about physical activity, and fear-avoidance beliefs about work. No indication was found that the reduction in pain-related fears in the graded activity group mediated more favorable return-to-work results in this group.

Workers who perceive their disability to be moderate and workers with moderate scores for fear-avoidance beliefs return to work more rapidly as a result of the graded activity intervention than workers with higher scores. The return to work of workers receiving the graded activity intervention is possibly independent from the reductions in pain-related fears caused by this intervention.

Keyword Absenteeism
Airplane crew
Avoidance behavior fear
Follow up
Low back pain
Physical activity
Proportional hazards model
Randomized controlled trial
Statistical significance
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Excellence in Research Australia (ERA) - Collection
School of Human Movement and Nutrition Sciences Publications
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Citation counts: TR Web of Science Citation Count  Cited 20 times in Thomson Reuters Web of Science Article | Citations
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Created: Wed, 31 Mar 2010, 16:25:47 EST by Jon Swabey on behalf of Faculty Of Health Sciences