Graded activity for low back pain in occupational health care: a randomized, controlled trial

Ann Intern Med. 2004 Jan 20;140(2):77-84. doi: 10.7326/0003-4819-140-2-200401200-00007.


Background: Low 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.

Objective: To determine the effectiveness of a behavior-oriented graded activity program compared with usual care.

Design: Randomized, controlled trial.

Setting: Occupational health services department of an airline company in the Netherlands.

Patients: 134 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).

Intervention: Graded activity, a physical exercise program based on operant-conditioning behavioral principles, to stimulate a rapid return to work.

Measurements: Outcomes 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).

Results: The 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.

Conclusions: Graded activity was more effective than usual care in reducing the number of days of absence from work because of low back pain.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Absenteeism
  • Behavior Therapy / methods*
  • Conditioning, Operant
  • Disability Evaluation
  • Exercise Therapy*
  • Humans
  • Low Back Pain / physiopathology
  • Low Back Pain / therapy*
  • Occupational Diseases / physiopathology
  • Occupational Diseases / therapy*
  • Occupational Health Services / methods*
  • Single-Blind Method
  • Treatment Outcome