• Eva Schonstein, D Kenny, J Keating, B Koes, and R D Herbert.
• School of Physiotherapy, Faculty of Health Sciences, The University of Sydney, New South Wales, Australia. e.schonstein@fhs.usyd.edu.au
• Spine. 2003 Oct 1; 28 (19): E391-5.

ObjectiveTo determine the effect on time lost from work of physical conditioning programs for workers with back and neck pain. DATA SOURCES Randomized trials were located by searching MEDLINE, EMBASE, CINAHL, PsycINFO, the Cochrane Controlled Trial Register, and PEDro.Review MethodsTwo reviewers independently extracted data and assessed trial quality. Where data could be pooled, meta-analysis was performed. Based on cost considerations, we nominated a mean saving of 10 sick days per year or a number needed to treat to return 1 person to work of 10 as the smallest treatment effects that would be clinically worthwhile.ResultsNineteen trials in 21 publications yielded 23 contrasts relevant to this review. These trials provide evidence that physical conditioning programs that included a cognitive-behavioral approach could produce a clinically worthwhile reduction in the number of sick days taken at 12 months (average of 45 days; 95% confidence interval 3-88) when compared to general practitioner care or advice for workers with chronic back pain. There was little evidence of an effect on time lost from work of specific exercise programs that did not include a cognitive-behavioral component.ConclusionPhysical conditioning programs that incorporate a cognitive-behavioral approach reduce the number of sick days for workers with chronic back pain when compared to usual care.

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