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 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.

Keywords::

• Behavioural graded activity
• graded activity
• low-back pain
• physiotherapy
• systematic review

Acknowledgements

The authors would like to thank J.M. Westeneng for selecting and assessing the methodological quality of the studies and suggestions. Furthermore our thanks go to E.M. Buining, for assisting in the literature search.

Declaration of Interest: The authors report no conflicts of interest.