Lindström I, Ohlund C, Eek C, Wallin L, Peterson L E, Nachemson A
Department of Orthopaedics, University of Göteborg, Sahlgren Hospital, Sweden.
Spine (Phila Pa 1976). 1992 Jun;17(6):641-52. doi: 10.1097/00007632-199206000-00003.
Patients with nonspecific mechanical low back pain (n = 103), examined by an orthopaedic surgeon and a social worker, were randomized to an activity group (n = 51) and a control group (n = 52). Patients with defined orthopaedic, medical, or psychiatric diagnoses were excluded before randomization. No patients were excluded due to place of birth or difficulties in speaking or understanding the Swedish language. The purpose of the study was to compare mobility, strength and fitness after traditional care and after traditional care plus a graded activity program with a behavioral therapy approach. A graded activity program, with a behavioral therapy approach was given under the guidance of a physical therapist. The endpoint of the graded activity program was return to work. This program significantly increased mobility, strength, and fitness more than could be explained by only a time recovery effect, especially in males. The patients in the activity group returned to work earlier than did the patients in the control group. Spinal rotation, abdominal muscle endurance time and lifting capacity were significantly correlated to rate of return to work. Traditional care plus a graded activity program were superior to only traditional care, evaluated in terms of mobility, strength and fitness. The graded activity program proved to be a successful method of restoring occupational function and facilitating return to work in subacute low back pain patients. The patients in the graded activity program learned that it is safe to move, while regaining function.
由骨科医生和社会工作者检查的非特异性机械性下背痛患者（n = 103）被随机分为活动组（n = 51）和对照组（n = 52）。在随机分组前，排除有明确骨科、内科或精神科诊断的患者。没有患者因出生地或在说或理解瑞典语方面有困难而被排除。本研究的目的是比较传统护理后以及传统护理加采用行为疗法的分级活动计划后的活动能力、力量和健康状况。在物理治疗师的指导下实施采用行为疗法的分级活动计划。分级活动计划的终点是重返工作岗位。该计划显著提高了活动能力、力量和健康状况，其提高程度超过仅由时间恢复效应所能解释的，尤其是在男性中。活动组的患者比对照组的患者更早重返工作岗位。脊柱旋转、腹肌耐力时间和举重能力与重返工作的比率显著相关。从活动能力、力量和健康状况方面评估，传统护理加分级活动计划优于仅采用传统护理。分级活动计划被证明是恢复亚急性下背痛患者职业功能和促进其重返工作岗位的一种成功方法。分级活动计划中的患者在恢复功能的同时，了解到活动是安全的。
