The short-term effects of graded activity versus physiotherapy in patients with chronic low back pain: A randomized controlled trial

• Graded activity and physiotherapy have similar effects in terms of reducing pain and disability.
• Healthcare professionals may identify inadequate beliefs in patients with LBP.
• It is important to stimulate patients with LBP return to work.

BackgroundChronic 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.Aimto compare the effectiveness of graded activity and physiotherapy in patients with chronic nonspecific low back pain.MethodsA 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).ResultsAfter 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.ConclusionThe 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.