Multidisciplinary rehabilitation for subacute low back pain: Graded activity or workplace intervention or both?: A randomized controlled trial

Authors: Anema, J. R., Steenstra, I. A., Bongers, P. M., de Vet, H. C. W., Knol, D. L., Loisel, P., & van Mechelen, W.
Year Published 2007
Publication Spine
Volume 32
Number 3
Pages 291-298
Publisher Lippincott Williams & Wilkins, Inc.

Low back pain (LBP) is the most common and expensive musculoskeletal disorder in industrialized countries. LBP is frequently associated with persistent or recurrent disability and absence from work. High costs are mainly due to sick leave and disability. Effective interventions for LBP are needed to prevent long-term disability and promote early and safe return to work.


To assess the effectiveness of workplace intervention and graded activity, separately and combined, for multidisciplinary rehabilitation of low back pain (LBP).


The setting was Dutch occupational health services and physiotherapy centers.


Participants sick-listed 2 to 6 weeks due to nonspecific LBP were randomized to workplace intervention (n = 96) or usual care (n = 100).

Data Collection

Workplace intervention consisted of workplace assessment, work modifications, and case management involving all stakeholders. Participants still sick-listed at 8 weeks were randomized for graded activity (n = 55) or usual care (n = 57). Graded activity comprised biweekly 1-hour exercise sessions based on operant-conditioning principles. Outcomes were lasting return to work, pain intensity and functional status, assessed at baseline, and at 12, 26, and 52 weeks after the start of sick leave.


The comparison was usual care.


Time until return to work for workers with workplace intervention was 77 versus 104 days (median) for workers without this intervention (P = 0.02). Workplace intervention was effective on return to work (hazard ratio = 1.7; 95% CI, 1.2–2.3; P = 0.002). Graded activity had a negative effect on return to work (hazard ratio = 0.4; 95% CI, 0.3–0.6; P < 0.001) and functional status. Combined intervention had no effect.


Workplace intervention is advised for multidisciplinary rehabilitation of subacute LBP. Graded activity or combined intervention is not advised.

Populations Male | Female
Outcomes Full-time employment | Part-time employment | Return to work
Research Design Randomized Controlled Trials (RCTs)
Peer Reviewed Yes