Graded Activity for Low Back Pain in Occupational Health Care A Randomized, Controlled Trial

Staal, J. Bart, Hlobil, Hynek, Twisk, Jos W. R., Smid, Tjabe, Köke, Albère J. A. and van Mechelen, Willem (2004) Graded Activity for Low Back Pain in Occupational Health Care A Randomized, Controlled Trial. Annals of Internal Medicine, 140 2: 77-84.


Author Staal, J. Bart
Hlobil, Hynek
Twisk, Jos W. R.
Smid, Tjabe
Köke, Albère J. A.
van Mechelen, Willem
Title Graded Activity for Low Back Pain in Occupational Health Care A Randomized, Controlled Trial
Journal name Annals of Internal Medicine   Check publisher's open access policy
ISSN 0003-4819
Publication date 2004-01-01
Open Access Status Not yet assessed
Volume 140
Issue 2
Start page 77
End page 84
Total pages 8
Place of publication Philadelphia, PA
Publisher American College of Physicians
Language eng
Subject 1103 Clinical Sciences
Formatted abstract
Background: Low back pain is a common medical and social problem frequently associated with disability and absence from work. However, data on effective return to work after interventions for low back pain are scarce.

Objective
: To determine the effectiveness of a behavior-oriented graded activity program compared with usual care.

Design: Randomized, controlled trial. Setting: Occupational health services department of an airline company in the Netherlands. Patients: 134 workers who were absent from work because of low back pain were randomly assigned to either graded activity (n = 67) or usual care (n = 67). Intervention: Graded activity, a physical exercise program based on operant-conditioning behavioral principles, to stimulate a rapid return to work. Measurements: Outcomes were the number of days of absence from work because of low back pain, functional status (Roland Disability Questionnaire), and severity of pain (11-point numerical scale).

Results: The median number of days of absence from work over 6 months of follow-up was 58 days in the graded activity group and 87 days in the usual care group. From randomization onward, graded activity was effective after 50 days of absence from work (hazard ratio, 1.9 [95% CI, 1.2 to 3.2]; P = 0.009). The graded activity group was more effective in improving functional status and pain than the usual care group. The effects, however, were small and not statistically significant.

Conclusions: Graded activity was more effective than usual care in reducing the number of days of absence from work because of low back pain

 
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Created: Mon, 06 Apr 2009, 20:28:19 EST by Maryanne Watson on behalf of School of Human Movement and Nutrition Sciences