Graded Activity and Graded Exposure for Persistent Nonspecific Low Back Pain: A Systematic Review.

The aim of this study was to systematically review randomized controlled trials that evaluated the effectiveness of graded activity or graded exposure for persistent (>6 weeks in duration or recurrent) low back pain. Fifteen trials with 1,654 patients were included. The trials had a median quality score of 6 (range=3–9). Pooled effects from 6 trials comparing graded activity with a minimal intervention or no treatment favored graded activity, with 4 contrasts being statistically significant: mean values (95% confidence intervals) for pain in the short term, pain in the intermediate term, disability in the short term, and disability in the intermediate term were –6.2 (–9.4 to –3.0), –5.5 (–9.9 to –1.0), –6.5 (–10.1 to –3.0), and –3.9 (–7.4 to –0.4), respectively. None of the pooled effects from 6 trials comparing graded activity with another form of exercise, from 4 trials comparing graded activity with graded exposure, and from 2 trials comparing graded exposure with a waiting list were statistically significant.

The available evidence suggests that graded activity in the short term and intermediate term is slightly more effective than a minimal intervention but not other forms of exercise for persistent low back pain. The limited evidence suggests that graded exposure is as effective as minimal treatment or graded activity for persistent low back pain.

Macedo, L. G., Smeets, R. J. E. M., Maher, C. G., Latimer, J., McAuley, J. H.. Graded Activity and Graded Exposure for Persistent Nonspecific Low Back Pain: A Systematic Review. Physical Therapy, April 15, online article ahead of print.

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