Trial reportOccupational and environmental medicine2006
The effectiveness of graded activity for low back pain in occupational healthcare.
Trial report in Occupational and environmental medicine, 2006. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 30 papers, 11 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
30 citing papers in PubMed, 11 syntheses or guidelines pooled it.
- Prognostic factors for return to work in patients affected by chronic low back pain: a systematic review.Musculoskeletal surgery · 2024Pooled it
- Rehabilitation of sick-listed LBP patients in occupational health with collaboration of the workplace.International journal of occupational medicine and environmental health · 2024Pooled it
- Multidisciplinary biopsychosocial rehabilitation for subacute low back pain.The Cochrane database of systematic reviews · 2017Pooled it
- The effect of journal impact factor, reporting conflicts, and reporting funding sources, on standardized effect sizes in back pain trials: a systematic review and meta-regression.BMC musculoskeletal disorders · 2015Pooled it
- Multidisciplinary biopsychosocial rehabilitation for chronic low back pain.The Cochrane database of systematic reviews · 2014Pooled it
- Physical conditioning as part of a return to work strategy to reduce sickness absence for workers with back pain.The Cochrane database of systematic reviews · 2013Pooled it
- Low back pain (acute).BMJ clinical evidence · 2011Pooled it
- The relationship between physical activity and low back pain outcomes: a systematic review of observational studies.European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2011Pooled it
- How is recovery from low back pain measured? A systematic review of the literature.European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2011Pooled it
- Behavioural treatment for chronic low-back pain.The Cochrane database of systematic reviews · 2010Pooled it
- Low back pain (acute).BMJ clinical evidence · 2008Pooled it
- Efficacy of Graded Activity with and without Daily-Monitored-Walking on Pain and Back Endurance among Patients with Concomitant Low-Back Pain and Type-2 Diabetes: A Randomized Trial.Ethiopian journal of health sciences · 2020Trial
- Effectiveness of three interventions for secondary prevention of low back pain in the occupational health setting - a randomised controlled trial with a natural course control.BMC public health · 2018Trial
- Randomised controlled trial of integrated care to reduce disability from chronic low back pain in working and private life.BMJ (Clinical research ed.) · 2010Trial
- An integrated care program to prevent work disability due to chronic low back pain: a process evaluation within a randomized controlled trial.BMC musculoskeletal disorders · 2009Trial
- Effectiveness of physical training for self-employed persons with musculoskeletal disorders: a randomized controlled trial.BMC public health · 2009Trial
- Subacute and chronic, non-specific back and neck pain: cognitive-behavioural rehabilitation versus primary care. A randomized controlled trial.BMC musculoskeletal disorders · 2008Trial
- Economic evaluation of a multi-stage return to work program for workers on sick-leave due to low back pain.Journal of occupational rehabilitation · 2006Trial
- Graded activity for acute and subacute low back pain.The Cochrane database of systematic reviews · 2025Article
- Image and perception of physicians as barriers to inter-disciplinary cooperation? - the example of German occupational health physicians in the rehabilitation process: a qualitative study.BMC health services research · 2018Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
6 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundLow back pain is a common medical and social problem associated with disability and absence from work. Knowledge on effective return to work (RTW) interventions is scarce.
objectiveTo determine the effectiveness of graded activity as part of a multistage RTW programme.
designRandomised controlled trial.
settingOccupational healthcare. SUBJECTS: 112 workers absent from work for more than eight weeks due to low back pain were randomised to either graded activity (n = 55) or usual care (n = 57).
interventionGraded activity, a physical exercise programme aimed at RTW based on operant-conditioning behavioural principles.
main outcome measuresThe number of days off work until first RTW for more then 28 days, total number of days on sick leave during follow up, functional status, and severity of pain. Follow up was 26 weeks.
resultsGraded activity prolonged RTW. Median time until RTW was equal to the total number of days on sick leave and was 139 (IQR = 69) days in the graded activity group and 111 (IQR = 76) days in the usual care group (hazard ratio = 0.52, 95% CI 0.32 to 0.86). An interaction between a prior workplace intervention and graded activity, together with a delay in the start of the graded activity intervention, explained most of the delay in RTW (hazard ratio = 0.86, 95% CI 0.40 to 1.84 without prior intervention and 0.39, 95% CI 0.19 to 0.81 with prior intervention). Graded activity did not improve pain or functional status clinically significantly.
conclusionsGraded activity was not effective for any of the outcome measures. Different interventions combined can lead to a delay in RTW. Delay in referral to graded activity delays RTW. In implementing graded activity special attention should be paid to the structure and process of care.
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