The effectiveness of graded activity in patients with non-specific low-back pain: a systematic review

Background: Non-specific low-back pain (LBP) is considered a major health and economic problem in Western society. Nowadays a common used intervention on non-specific LBP is graded activity (GA). Graded Activity developed by Lindström et al., consisted of four parts: (i) measurements of functional c...

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Bibliographic Details
Published in:	Disability and rehabilitation Vol. 34; no. 13; pp. 1070 - 1076
Main Authors:	van der Giessen, R. N., Speksnijder, C. M., Helders, P. J. M.
Format:	Journal Article
Language:	English
Published:	England Informa Healthcare 01-01-2012 Taylor & Francis
Subjects:	Adult Behavioural approaches Behavioural graded activity Disability Evaluation Exercise Exercise Therapy graded activity Humans Low Back Pain - rehabilitation Low Back Pain - therapy low-back pain Pain Patient Education as Topic - methods physiotherapy Randomized controlled trials Randomized Controlled Trials as Topic Rehabilitation Return to work systematic review Time Factors Treatment Outcome Work
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Summary:	Background: Non-specific low-back pain (LBP) is considered a major health and economic problem in Western society. Nowadays a common used intervention on non-specific LBP is graded activity (GA). Graded Activity developed by Lindström et al., consisted of four parts: (i) measurements of functional capacity; (ii) a work-place visit; (iii) back school education and (iv) an individual, sub-maximal, gradually increased exercise program with an operant-conditioning behavioural approach as described by Fordyce et al. Objective: To evaluate the effectiveness of GA in adults with non-specific LBP on pain, disabilities and return to work. Data sources: An extensive literature search of PubMed, Embase, CINAHL and The Cochrane Library was conducted in July 2011. Review Methods: Randomized controlled trials (RCTs) evaluating the effect of GA in patients with non-specific LBP were eligible. Methodological quality of the studies was assessed according to the PEDro scale. A best-evidence synthesis was conducted according to van Peppen et al. to interpret the outcomes of the included studies. Results: Ten articles were included in this systematic review; these articles described five RCTs (680 patients). The best-evidence synthesis revealed that there was no or insufficient evidence for a positive effect of GA on pain, disabilities and return to work in patients with non-specific LBP. Conclusion: Currently there is no or insufficient evidence that GA results in better outcomes of patients with non-specific LBP. Implications for Rehabilitation Graded Activity in non-specific low-back pain Non-specific low-back pain is not only a physical problem but can be influenced by patient's beliefs, psychological distress and illness behaviour. In clinical practise the use of Graded Activity (GA) can be recommend when a discrepancy between musculoskeletal functioning and disabilities are present in a patient, for instance the presence of kinesiophobia. There is no or insufficient evidence that GA results in better outcomes than usual care.
Bibliography:	SourceType-Scholarly Journals-1 ObjectType-Feature-4 ObjectType-Undefined-1 content type line 23 ObjectType-Review-2 ObjectType-Article-3 ObjectType-Article-1 ObjectType-Feature-2
ISSN:	0963-8288 1464-5165
DOI:	10.3109/09638288.2011.631682