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Graded Exercise for Low Back Pain Reduces Work Absence

Am Fam Physician. 2004 Sep 1;70(5):978-980.

Low back pain is a common cause of disability and absence from work. Active rehabilitation strategies—such as physical exercise, operant conditioning, and behavioral treatment—help workers resume normal activity. Graded physical activity specifically has been found to reduce work absences.

Staal and associates used a randomized controlled trial to determine the usefulness of graded physical activity compared with traditional care in reducing the number of days an employee was absent from work. Employees of KLM Royal Dutch Airlines in the Netherlands who were absent from work because of back pain and who could safely exercise were randomly assigned to graded physical activity or usual care.

Patients in the intervention group received usual guidance and graded physical activity consisting of two one-hour exercise sessions weekly until they returned to work or until three months had elapsed. The exercise sessions consisted of general and individually tailored exercises to increase strength and address specific work activities. Exercise goals and time of return to work were determined jointly by the patient and the physician. Emotional support also was given. Subjects assigned to the usual care group received usual guidance.

The median total number of days subjects were absent from work was 58 in the graded physical activity group and 87 in the usual-care group. The variation was most apparent after 50 days of treatment. Both groups improved similarly in functional status and pain reporting for the duration of the study.

The authors conclude that graded physical activity programs can decrease the time lost from work for low back pain. Severity of pain was not ameliorated; however, this was expected because graded physical activity intervention is directed at improving function and return to work and not at pain relief. Emphasizing workers’ perceptions of their medical condition and focusing on abilities rather than disabilities may help them understand that their pain is benign.

In an editorial in the same journal, Weinstein reiterates the effect of helping patients understand that pain does not have to affect function. Psychosocial issues may be the predominant reason that persons with pain become disabled.

Staal JB, et al. Graded activity for low back pain in occupational health care. Ann Intern Med January 20, 2004;140:77–84, and Weinstein J. Absent from work: nature versus nurture [Editorial]. Ann Intern Med. January 20, 2004140:142–3.


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