title: 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.
  
  
  METHODS
  An extensive literature search of PubMed, Embase, CINAHL and The Cochrane Library was conducted in July 2011.
  
  
  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.
  
  
  CONCLUSIONS
  Currently there is no or insufficient evidence that GA results in better outcomes of patients with non-specific LBP.
authors.affiliation: Department of Physiotherapy Science, Clinical Health Sciences, Utrecht University, Utrecht, The Netherlands.
authors.forename: R N
authors.initials: RN
authors.lastname: van der Giessen
authors.forename: C M
authors.initials: CM
authors.lastname: Speksnijder
authors.forename: P J M
authors.initials: PJ
authors.lastname: Helders
mesh_terms: D000328:Adult; D004185:Disability Evaluation; D005081:Exercise Therapy; D006801:Humans; D017116:Low Back Pain / Q000534:rehabilitation* / Q000628:therapy; D010353:Patient Education as Topic / Q000379:methods*; D016032:Randomized Controlled Trials as Topic; D013997:Time Factors; D016896:Treatment Outcome; D014937:Work