• J Bart Staal, Hynek Hlobil, Jos W R Twisk, Tjabe Smid, Albère J A Köke, and Willem van Mechelen.
• Institute for Research in Extramural Medicine and the Department of Social Medicine, VU University Medical Center, Amsterdam, The Netherlands.
• Ann. Intern. Med. 2004 Jan 20; 140 (2): 77-84.

BackgroundLow 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.ObjectiveTo determine the effectiveness of a behavior-oriented graded activity program compared with usual care.DesignRandomized, controlled trial.SettingOccupational health services department of an airline company in the Netherlands.Patients134 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).InterventionGraded activity, a physical exercise program based on operant-conditioning behavioral principles, to stimulate a rapid return to work.MeasurementsOutcomes 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).ResultsThe 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.ConclusionsGraded 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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