THE EFFECT OF GRADED ACTIVITY ON PATIENTS WITH SUBACUTE LOW-BACK-PAIN- A RANDOMIZED PROSPECTIVE CLINICAL-STUDY WITH AN OPERANT-CONDITIONING BEHAVIORAL-APPROACH

The aim of this study was to determine whether graded activity restore d occupational function in industrial blue-collar workers who were sic k-listed for 8 weeks because of subacute, nonspecific, mechanical low back pain (LBP). Patients with LBP, who had been examined by an orthop edic surgeon and a social worker, were randomly assigned to either an activity group (n = 51) or a control group (n = 52). Patients with def ined orthopedic, medical, or psychiatric diagnoses were excluded befor e randomization. The graded activity program consisted of four parts: (1) measurements of functional capacity; (2) a work-place visit; (3) b ack school education; and (4) an individual, submaximal, gradually inc reased exercise program, with an operant-conditioning behavioral appro ach, based on the results of the tests and the demands of the patient' s work. Records of the amount of sick leave taken over a 3-year period (ie, the 1-year periods before, during, and after intervention) were obtained from each patient's Social Insurance Office. The patients in the activity group returned to work significantly earlier than did the patients in the control group. The median number of physical therapis t appointments before return to work was 5, and the average number of appointments was 10.7 (SD = 12.3). The average duration of sick leave attributable to LBP during the second follow-up year was 12.1 weeks (S D = 18.4) in the activity group and 19.6 weeks (SD = 20.7) in the cont rol group. Four patients in the control group and 1 patient in the act ivity group received permanent disability pensions. The graded activit y program made the patients occupationally functional again, as measur ed by return to work and significantly reduced long-term sick leave.