A behavioural-oriented graded activity program reduced the number of days absent from work because of low back pain.

Question Is a behavioural-oriented graded activity program more effective than usual care in reducing sick leave and improving functional status in employees absent from work due to low back pain. Design Randomised controlled trial. Setting Occupational health services department of an airline company in the Netherlands. Patients 134 workers absent from work because of nonspecific low back pain and low back pain symptoms with a minimum duration of four weeks in succession. Interventions The participants attended 1-hour graded exercise sessions twice per week until they returned completely to regular work or until the maximum therapy duration of three months was reached. Physiotherapists trained specifically to treat patients with low back pain according to behavioural principles supervised the sessions. Maximal performance was assessed for each exercise separately, and was used as a baseline value for specifying a gradually progressive exercise scheme. The primary goal of the physical exercises was not to improve physical performance but to make the disabled worker aware that it was safe to move and to be physically active. The usual care group received the usual guidance and advice. Other types of treatment were not required. Outcomes Number of days on sick leave because of low back pain, functional status (Roland Disability Questionnaire), and severity of pain (11-point numerical scale). Result In the first 50 days after randomisation, the rate of return to work was similar in both groups [hazard ratio 1.0 (95% CI 0.6 to 1.8, p > 0.2)]. For the period from 50 days after randomisation there was a difference in favour of the graded activity group [hazard ratio 1.9 (95% CI 1.2 to 3.2, p = 0.009)]. For pain and functional status there were little or no differences between the groups. Conclusion For patients with low back pain, graded activity was more effective than usual care in reducing the length of sick leave.