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Effectiveness of graded activity in pts w/ non-specific low-back pain-systematic revw


Senior Member
Non-specific low-back pain isn't ME/CFS of course. But the finding is interesting.

The effectiveness of graded activity in patients with non-specific low-back pain: a systematic review

2012, Vol. 34, No. 13 , Pages 1070-1076 (doi:10.3109/09638288.2011.631682)

R. N. van der Giessen1, C. M. Speksnijder1,2,3, P. J. M. Helders1,3

1Department of Physiotherapy Science, Clinical Health Sciences, Utrecht University, Utrecht, The Netherlands
2Department of Oral and Maxillofacial Surgery and Special Dental Care, University Medical Center Utrecht, Utrecht, The Netherlands
3Department of Physical Therapy & Exercise Physiology, University Hospital for Children and Youth Het Wilhelmina Kinderziekenhuis, University Medical Center Utrecht, Utrecht, The Netherlands
Correspondence: Dr. C. M. Speksnijder, UMC Utrecht, G05.122, P.O. Box 85090, 3508 AB Utrecht. Tel: +31 88 7568040 . E-mail: C.M.Speksnijder@umcutrecht.nl


Non-specific low-back pain (LBP) is considered a major health and economic problem in Western society.

Nowadays a common used intervention on non-specific LBP is graded activity (GA).

Graded Activity developed by Lindstrm et al., consisted of four parts:
(i) measurements of functional capacity;
(ii) a work-place visit;
(iii) back school education
(iv) an individual, sub-maximal, gradually increased exercise program with an operant-conditioning behavioural approach as described by Fordyce et al.


To evaluate the effectiveness of GA in adults with non-specific LBP on pain, disabilities and return to work.

Data sources:

An extensive literature search of PubMed, Embase, CINAHL and The Cochrane Library was conducted in July 2011.

Review Methods:

Randomized controlled trials (RCTs) evaluating the effect of GA in patients with non-specific LBP were eligible.

Methodological quality of the studies was assessed according to the PEDro scale.

A best-evidence synthesis was conducted according to van Peppen et al. to interpret the outcomes of the included studies.


Ten articles were included in this systematic review; these articles described five RCTs (680 patients).

The best-evidence synthesis revealed that there was no or insufficient evidence for a positive effect of GA on pain, disabilities and return to work in patients with non-specific LBP.


Currently there is no or insufficient evidence that GA results in better outcomes of patients with non-specific LBP.


Implications for Rehabilitation

Graded Activity in non-specific low-back pain

Non-specific low-back pain is not only a physical problem but can be influenced by patients beliefs, psychological distress and illness behaviour.

In clinical practise the use of Graded Activity (GA) can be recommend when a discrepancy between musculoskeletal functioning and disabilities are present in a patient, for instance the presence of kinesiophobia.

There is no or insufficient evidence that GA results in better outcomes than usual care.


Behavioural graded activity, graded activity, low-back pain, physiotherapy, systematic review

Read More: http://informahealthcare.com/doi/abs/10.3109/09638288.2011.631682


Senior Member
Southeast US
Interesting, Dolphin. I know plenty of 60+ people who suffer crippling low back pain. Those of us with Fibro/ME have it especially bad. Here at home we share a heating pad which just lives on the sofa. I can still see my Fibro/ME friend with the wires of her TENS unit hanging out of her shirt.

I wonder if anyone has studied the effect of a heavy laptop on one's lap for hours. That seems to aggravate my lower back no matter what my position.
Sofa, UK
Thanks Dolphin. My lower back pain has been flaring up in recent weeks. For me, anti-inflammatories, rest, and some very light, short daily walks to keep my back moving have always been the most beneficial.

The fundamental cause for me, though, is the position I fall asleep in. And underlying all of that is the allodynia/sensitivity to fabrics which restricts how I can sleep, and some kind of sleep problem which means I don't move during the night anyway - I wake up with really bad pack pain some days and immediately I can feel how my sleep posture has caused that.

I do believe that very gentle walking is generally very important for back pain - you've got to get your back moving somehow, that does so much to get all the back muscles moving properly - and I can walk gently for short periods (though I still can't stand still without pain, after all these years). But graded exercise? If that suggests 'pushing it' in any way, that's not going to ever be a good idea for chronic back pain in my experience; the hardest part is restraining yourself and keeping it as smooth and gentle as possible - in my experience, at least...


Doing Well
Good points Mark.

BEG, I bought a table similar to those found in hospital from ebay. They make ones specifically for laptops that tilt & adjust height etc.