Staal J Bart, Hlobil Hynek, Twisk Jos W R, Smid Tjabe, Köke Albère J A, van Mechelen Willem
Institute for Research in Extramural Medicine and the Department of Social Medicine, VU University Medical Center, Amsterdam, The Netherlands.
Ann Intern Med. 2004 Jan 20;140(2):77-84. doi: 10.7326/0003-4819-140-2-200401200-00007.
Low back pain is a common medical and social problem frequently associated with disability and absence from work. However, data on effective return to work after interventions for low back pain are scarce.
To determine the effectiveness of a behavior-oriented graded activity program compared with usual care.
Randomized, controlled trial.
Occupational health services department of an airline company in the Netherlands.
134 workers who were absent from work because of low back pain were randomly assigned to either graded activity (n = 67) or usual care (n = 67).
Graded activity, a physical exercise program based on operant-conditioning behavioral principles, to stimulate a rapid return to work.
Outcomes were the number of days of absence from work because of low back pain, functional status (Roland Disability Questionnaire), and severity of pain (11-point numerical scale).
The median number of days of absence from work over 6 months of follow-up was 58 days in the graded activity group and 87 days in the usual care group. From randomization onward, graded activity was effective after 50 days of absence from work (hazard ratio, 1.9 [95% CI, 1.2 to 3.2]; P = 0.009). The graded activity group was more effective in improving functional status and pain than the usual care group. The effects, however, were small and not statistically significant.
Graded activity was more effective than usual care in reducing the number of days of absence from work because of low back pain.
腰痛是一个常见的医学和社会问题，常与残疾和缺勤相关。然而，关于腰痛干预后有效重返工作岗位的数据却很稀少。
确定与常规护理相比，以行为为导向的分级活动计划的有效性。
随机对照试验。
荷兰一家航空公司的职业健康服务部门。
134名因腰痛而缺勤的工人被随机分为分级活动组（n = 67）或常规护理组（n = 67）。
分级活动，一种基于操作性条件反射行为原则的体育锻炼计划，以促进快速重返工作岗位。
结果指标为因腰痛缺勤的天数、功能状态（罗兰残疾问卷）和疼痛严重程度（11点数字评分量表）。
在6个月的随访中，分级活动组因腰痛缺勤的中位数天数为58天，常规护理组为87天。从随机分组开始，在缺勤50天后分级活动就显示出效果（风险比，1.9 [95% CI，1.2至3.2]；P = 0.009）。分级活动组在改善功能状态和疼痛方面比常规护理组更有效。然而，这些效果较小且无统计学意义。
在减少因腰痛而缺勤的天数方面，分级活动比常规护理更有效。
