Lindstrom I, Ohlund C, Eek C, Wallin L, Peterson L, Fordyce W, Nachemson A Effect of Graded Activity on Patients with Subacute Low Back Pain: A Randomised Prospective Clinical Study with Operant-Conditioning Behavioural Approach. Physical Therapy 1992, Vol 72, No 4: 279-293

The aim of this study was to determine whether graded activity restored occupational function in industrial blue collar workers who were sick-listed for 8 weeks because of non-specific subacute mechanical low back pain. The experimental group had four parts, viz functional capacity assessment, a workplace visit, back education, individualised, submaximal graded activity programme with an operant-conditioning behavioural approach. The control group had traditional care as ordered by their physician.

The activity group had returned to work and were work ready significantly earlier than the control group and had less number of appointments to the physical therapist and less number of sick days in the following year than the control group

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K Reilly, MA; Lovejoy B, Williams and Roth H: Differences between a Supervised and Independent Strength and Conditioning Program with Chronic Low Back Pain Syndromes. Journal of Occupational Medicine 1989; Vol 31 No. 6 June

The purpose of this randomly controlled, prospective trial was to evaluate the physiological parameters seen in a group of patients with chronic low back syndrome assigned to a supervised or independent exercise programme. Forty male and female subjects were evenly matched for age, sex, months of pain, exercise experience and surgical procedures before being assigned randomly to two groups. The study period was 6 months (96 sessions).

Results showed the experimental (supervised exercise) group had markedly greater strength and endurance than the control (independent exercise) group and had an average of 50 points lower in intensity of self reported pain. The experimental group also had a significantly lower percentage body fat composition, lower resting heart rate and lower diastolic blood pressure. The experimental group reported only an average of 0.25 relapses to the control group’s 3.05.

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Bendix AF, Bendix T, Ostenfeld S, Bush E, Andersen A. Active treatment programs for patients with chronic low back pain: a prospective, randomized, observer-blinded study. European Spine Journal; 1995: 4:148-152

The aim of this study was to evaluate the rehabilitation outcome of three different active programmes in terms of (1) work readiness, (2) days of sick leave, (3) health care contacts, (4) pain and disability scores and (5) staying physically active. A blinded observer assessed them, 4 months after the completion of the programme.

Group (1) had 39 hours of multidisciplinary input including a large component of exercise and education over 6 weeks; group (2) had 24 hours of exercise and education and group (3) had an active combined psycho-physical programme. Results showed group one to be superior in work readiness rate, back and leg pain perception and function.

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O’Sullivan P, Twomey L and Allison G. Evaluation of Specific Stabilizing Exercise in the Treatment of Chronic Low Back Pain with Radiologic Diagnosis of Spondylolysis and Spondylolisthesis. Spine 1997, Vol 22, No 24: 2959-2967

Physiotherapy management of back pain has been focused on specifically developing the deep abdominal and deep spinal muscles with special exercises to stabilise the back.

Two randomly selected groups underwent either a 10 week specific exercise programme for these muscles or the usual treatment from their treating practitioner. The experimental (specific exercise) group showed a statistically significant reduction in pain intensity and functional disability that was maintained at a 30 month follow up.

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Gundewall B, Liljeqvist M, and Hansson Y. Primary Prevention of Back Symptoms and Absence from Work. A Prospective Randomised Study Among Hospital Employees. Spine l993, Vol 18 No 5: 587-594

The personnel at a geriatric hospital were randomly assigned to either an exercise group participating in work hours or a group that did not receive any further advice or information.

At a 13 month followup, there was a significant increase in strength, decrease in absence from work due to back pain (experimental group = 1 person off for 28 days; control group = 12 people off for 155 days), decrease in back pain complaints and in the intensity of back pain.

The cost benefit ratio was greater than 10, with one hour spent by the physiotherapist reducing the work absence amongst the participants by 1.3 days.

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Linton SJ, Bradley LA, Jensen I, Spangfort E and Sundell L. The secondary prevention of low back pain: a controlled study with follow-up.

The current investigation studied the effectiveness of a secondary prevention program for nurses with back problems who are deemed at risk of developing a chronic problem. The randomly assigned treatment group received a physical and behavioural management package, the control group was placed on a waiting list.

The treatment group had a significantly greater improvement than the control group in pain intensity, anxiety, sleep quality and fatigue ratings, observed pain behaviour, activities, mood and helplessness. These differences were generally maintained at the 6 month follow up. In addition, the treatment group broke a trend for increasing amounts of pain related absenteeism whilst the control group did not. The conclusion is that a secondary prevention programme is an effective method for dealing with musculoskeletal problems progressing to a chronic stage.

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