The short-term effects of graded activity versus physiotherapy in patients with chronic low back pain: A randomized controlled trial.
BACKGROUND
Chronic low back pain is one of the most common problematic health conditions worldwide and is highly associated with disability, quality of life, emotional changes, and work absenteeism. Graded activity programs, based on cognitive behavioral therapy, and exercises are common treatments for patients with low back pain. However, recent evidence has shown that there is no evidence to support graded activity for patients with chronic nonspecific low back pain.


OBJECTIVE
to compare the effectiveness of graded activity and physiotherapy in patients with chronic nonspecific low back pain.


METHODS
A total of 66 patients with chronic nonspecific low back pain were randomized to perform either graded activity (moderate intensity treadmill walking, brief education and strength exercises) or physiotherapy (strengthening, stretching and motor control). These patients received individual sessions twice a week for six weeks. The primary measures were intensity of pain (Pain Numerical Rating Scale) and disability (Rolland Morris Disability Questionnaire).


RESULTS
After six weeks, significant improvements have been observed in all outcome measures of both groups, with a non-significant difference between the groups. For intensity of pain (mean difference = 0.1 points, 95% confidence interval [CI] = -1.1-1.3) and disability (mean difference = 0.8 points, 95% confidence interval [CI] = -2.6-4.2). No differences were found in the remaining outcomes.


CONCLUSIONS
The results of this study suggest that graded activity and physiotherapy showed to be effective and have similar effects for patients with chronic nonspecific low back pain.
Physical Therapy, Speech and Occupational Therapy Department, School of Medicine, University of São Paulo, São Paulo, Brazil. Electronic address: m.magalhaes@usp.br.
Mauricio Oliveira
MO
Magalhães
Physical Therapy, Speech and Occupational Therapy Department, School of Medicine, University of São Paulo, São Paulo, Brazil.
Luzilauri Harumi
LH
Muzi
Physical Therapy, Speech and Occupational Therapy Department, School of Medicine, University of São Paulo, São Paulo, Brazil.
Josielli
J
Comachio
Physical Therapy, Speech and Occupational Therapy Department, School of Medicine, University of São Paulo, São Paulo, Brazil; Bioscience Division, Federal University of São Paulo, São Paulo, Brazil.
Thomaz Nogueira
TN
Burke
Physical Therapy, Speech and Occupational Therapy Department, School of Medicine, University of São Paulo, São Paulo, Brazil.
Fabio Jorge
FJ
Renovato França
Physical Therapy, Speech and Occupational Therapy Department, School of Medicine, University of São Paulo, São Paulo, Brazil; University Federal do Amapá, Campus Binacional do Oiapoque, Amapá, Brazil.
Luiz Armando
LA
Vidal Ramos
Physical Therapy, Speech and Occupational Therapy Department, School of Medicine, University of São Paulo, São Paulo, Brazil; Physical Therapy Division, School of Medicine, Federal University of Ceará, Ceará, Brazil.
Gabriel Peixoto
GP
Leão Almeida
Physical Therapy, Speech and Occupational Therapy Department, School of Medicine, University of São Paulo, São Paulo, Brazil.
Ana Paula
AP
de Moura Campos Carvalho-e-Silva
Physical Therapy, Speech and Occupational Therapy Department, School of Medicine, University of São Paulo, São Paulo, Brazil.
Amélia Pasqual
AP
Marques
D000328:Adult; D032763:Behavior Control / Q000379:methods*; D015444:Exercise; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D006266:Health Education / Q000379:methods*; D006304:Health Status; D006801:Humans; D017116:Low Back Pain / Q000523:psychology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D011788:Quality of Life
Exercise; Low back pain; Physiotherapy; Rehabilitation