The effectiveness of graded activity for low back pain in occupational healthcare

I A Steenstra, J R Anema, P M Bongers, H C W de Vet, D L Knol, W van Mechelen

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

BACKGROUND: Low back pain is a common medical and social problem associated with disability and absence from work. Knowledge on effective return to work (RTW) interventions is scarce.

OBJECTIVE: To determine the effectiveness of graded activity as part of a multistage RTW programme.

DESIGN: Randomised controlled trial.

SETTING: Occupational healthcare.

SUBJECTS: 112 workers absent from work for more than eight weeks due to low back pain were randomised to either graded activity (n = 55) or usual care (n = 57).

INTERVENTION: Graded activity, a physical exercise programme aimed at RTW based on operant-conditioning behavioural principles.

MAIN OUTCOME MEASURES: The number of days off work until first RTW for more then 28 days, total number of days on sick leave during follow up, functional status, and severity of pain. Follow up was 26 weeks.

RESULTS: Graded activity prolonged RTW. Median time until RTW was equal to the total number of days on sick leave and was 139 (IQR = 69) days in the graded activity group and 111 (IQR = 76) days in the usual care group (hazard ratio = 0.52, 95% CI 0.32 to 0.86). An interaction between a prior workplace intervention and graded activity, together with a delay in the start of the graded activity intervention, explained most of the delay in RTW (hazard ratio = 0.86, 95% CI 0.40 to 1.84 without prior intervention and 0.39, 95% CI 0.19 to 0.81 with prior intervention). Graded activity did not improve pain or functional status clinically significantly.

CONCLUSIONS: Graded activity was not effective for any of the outcome measures. Different interventions combined can lead to a delay in RTW. Delay in referral to graded activity delays RTW. In implementing graded activity special attention should be paid to the structure and process of care.

Original languageEnglish
Pages (from-to)718-25
Number of pages8
JournalOccupational and Environmental Medicine
Volume63
Issue number11
DOIs
Publication statusPublished - Nov 2006

Cite this

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title = "The effectiveness of graded activity for low back pain in occupational healthcare",
abstract = "BACKGROUND: Low back pain is a common medical and social problem associated with disability and absence from work. Knowledge on effective return to work (RTW) interventions is scarce.OBJECTIVE: To determine the effectiveness of graded activity as part of a multistage RTW programme.DESIGN: Randomised controlled trial.SETTING: Occupational healthcare.SUBJECTS: 112 workers absent from work for more than eight weeks due to low back pain were randomised to either graded activity (n = 55) or usual care (n = 57).INTERVENTION: Graded activity, a physical exercise programme aimed at RTW based on operant-conditioning behavioural principles.MAIN OUTCOME MEASURES: The number of days off work until first RTW for more then 28 days, total number of days on sick leave during follow up, functional status, and severity of pain. Follow up was 26 weeks.RESULTS: Graded activity prolonged RTW. Median time until RTW was equal to the total number of days on sick leave and was 139 (IQR = 69) days in the graded activity group and 111 (IQR = 76) days in the usual care group (hazard ratio = 0.52, 95{\%} CI 0.32 to 0.86). An interaction between a prior workplace intervention and graded activity, together with a delay in the start of the graded activity intervention, explained most of the delay in RTW (hazard ratio = 0.86, 95{\%} CI 0.40 to 1.84 without prior intervention and 0.39, 95{\%} CI 0.19 to 0.81 with prior intervention). Graded activity did not improve pain or functional status clinically significantly.CONCLUSIONS: Graded activity was not effective for any of the outcome measures. Different interventions combined can lead to a delay in RTW. Delay in referral to graded activity delays RTW. In implementing graded activity special attention should be paid to the structure and process of care.",
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year = "2006",
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The effectiveness of graded activity for low back pain in occupational healthcare. / Steenstra, I A; Anema, J R; Bongers, P M; de Vet, H C W; Knol, D L; van Mechelen, W.

In: Occupational and Environmental Medicine, Vol. 63, No. 11, 11.2006, p. 718-25.

Research output: Contribution to journalArticleAcademicpeer-review

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T1 - The effectiveness of graded activity for low back pain in occupational healthcare

AU - Steenstra, I A

AU - Anema, J R

AU - Bongers, P M

AU - de Vet, H C W

AU - Knol, D L

AU - van Mechelen, W

PY - 2006/11

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N2 - BACKGROUND: Low back pain is a common medical and social problem associated with disability and absence from work. Knowledge on effective return to work (RTW) interventions is scarce.OBJECTIVE: To determine the effectiveness of graded activity as part of a multistage RTW programme.DESIGN: Randomised controlled trial.SETTING: Occupational healthcare.SUBJECTS: 112 workers absent from work for more than eight weeks due to low back pain were randomised to either graded activity (n = 55) or usual care (n = 57).INTERVENTION: Graded activity, a physical exercise programme aimed at RTW based on operant-conditioning behavioural principles.MAIN OUTCOME MEASURES: The number of days off work until first RTW for more then 28 days, total number of days on sick leave during follow up, functional status, and severity of pain. Follow up was 26 weeks.RESULTS: Graded activity prolonged RTW. Median time until RTW was equal to the total number of days on sick leave and was 139 (IQR = 69) days in the graded activity group and 111 (IQR = 76) days in the usual care group (hazard ratio = 0.52, 95% CI 0.32 to 0.86). An interaction between a prior workplace intervention and graded activity, together with a delay in the start of the graded activity intervention, explained most of the delay in RTW (hazard ratio = 0.86, 95% CI 0.40 to 1.84 without prior intervention and 0.39, 95% CI 0.19 to 0.81 with prior intervention). Graded activity did not improve pain or functional status clinically significantly.CONCLUSIONS: Graded activity was not effective for any of the outcome measures. Different interventions combined can lead to a delay in RTW. Delay in referral to graded activity delays RTW. In implementing graded activity special attention should be paid to the structure and process of care.

AB - BACKGROUND: Low back pain is a common medical and social problem associated with disability and absence from work. Knowledge on effective return to work (RTW) interventions is scarce.OBJECTIVE: To determine the effectiveness of graded activity as part of a multistage RTW programme.DESIGN: Randomised controlled trial.SETTING: Occupational healthcare.SUBJECTS: 112 workers absent from work for more than eight weeks due to low back pain were randomised to either graded activity (n = 55) or usual care (n = 57).INTERVENTION: Graded activity, a physical exercise programme aimed at RTW based on operant-conditioning behavioural principles.MAIN OUTCOME MEASURES: The number of days off work until first RTW for more then 28 days, total number of days on sick leave during follow up, functional status, and severity of pain. Follow up was 26 weeks.RESULTS: Graded activity prolonged RTW. Median time until RTW was equal to the total number of days on sick leave and was 139 (IQR = 69) days in the graded activity group and 111 (IQR = 76) days in the usual care group (hazard ratio = 0.52, 95% CI 0.32 to 0.86). An interaction between a prior workplace intervention and graded activity, together with a delay in the start of the graded activity intervention, explained most of the delay in RTW (hazard ratio = 0.86, 95% CI 0.40 to 1.84 without prior intervention and 0.39, 95% CI 0.19 to 0.81 with prior intervention). Graded activity did not improve pain or functional status clinically significantly.CONCLUSIONS: Graded activity was not effective for any of the outcome measures. Different interventions combined can lead to a delay in RTW. Delay in referral to graded activity delays RTW. In implementing graded activity special attention should be paid to the structure and process of care.

KW - Adolescent

KW - Adult

KW - Aged

KW - Behavior Therapy/methods

KW - Disability Evaluation

KW - Exercise Therapy

KW - Female

KW - Humans

KW - Low Back Pain/diagnosis

KW - Male

KW - Middle Aged

KW - Occupational Health Services/methods

KW - Pain Measurement

KW - Sick Leave

U2 - 10.1136/oem.2005.021675

DO - 10.1136/oem.2005.021675

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JO - Occupational and Environmental Medicine

JF - Occupational and Environmental Medicine

SN - 1351-0711

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ER -