title: Graded activity for low back pain in occupational health care: a randomized, controlled trial.
abstract: 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.
  
  
  METHODS
  Randomized, controlled trial.
  
  
  METHODS
  Occupational health services department of an airline company in the Netherlands.
  
  
  METHODS
  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).
  
  
  METHODS
  Graded activity, a physical exercise program based on operant-conditioning behavioral principles, to stimulate a rapid return to work.
  
  
  METHODS
  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.
authors.affiliation: Institute for Research in Extramural Medicine and the Department of Social Medicine, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: J Bart
authors.initials: JB
authors.lastname: Staal
authors.forename: Hynek
authors.initials: H
authors.lastname: Hlobil
authors.forename: Jos W R
authors.initials: JW
authors.lastname: Twisk
authors.forename: Tjabe
authors.initials: T
authors.lastname: Smid
authors.forename: Albère J A
authors.initials: AJ
authors.lastname: Köke
authors.forename: Willem
authors.initials: W
authors.lastname: van Mechelen
mesh_terms: D000041:Absenteeism; D001521:Behavior Therapy / Q000379:methods*; D003216:Conditioning, Operant; D004185:Disability Evaluation; D005081:Exercise Therapy; D006801:Humans; D017116:Low Back Pain / Q000503:physiopathology / Q000628:therapy*; D009784:Occupational Diseases / Q000503:physiopathology / Q000628:therapy*; D009786:Occupational Health Services / Q000379:methods*; D016037:Single-Blind Method; D016896:Treatment Outcome