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

Abstract

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 RehabilitationGraded Activity in non-specific low-back painNon-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.