Effectiveness of graded activity versus physiotherapy in patients with chronic nonspecific low back pain: midterm follow up results of a randomized controlled trial.
Maurício Oliveira Magalhães, Josielli Comachio, Paulo Henrique Ferreira and 2 others
PMID 28803704WHAT IT FOUND
For chronic nonspecific low back pain, graded activity and physiotherapy exercises worked similarly at three and six months.
Pain and disability improved in both groups, and neither approach was clearly better.
Key findings
01At 3 and 6 months, there were no between-group differences for pain intensity or disability.
02At 6 months, pain scores were 4.1 and 4.0 and disability scores were 7.4 in both groups.
03Daily physical activity favored graded activity at posttreatment, but no between-group differences remained at 3 or 6 months.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
Therapists and participants were not blinded to group allocation, which can affect reported pain and disability. The study had no control or placebo group, so it cannot show whether either exercise approach was better than no treatment. Participants had chronic nonspecific low back pain and were aged 18 to 65 years, with serious spinal pathology, nerve root compromise, pregnancy, high blood pressure, and cardio-respiratory illness excluded, so results may not apply to more acute or medically complex patients. Follow-up was only three and six months, so longer-term effects are unknown. The supplied text does not report how many participants completed the trial or were analysed at each follow-up. The interventions were delivered by a single therapist with 10 hours of training, so results may not generalize to clinics with different staffing or training.
Declared interests
The authors declared no conflicts of interest.
The easy way to misread this
Do not conclude that graded activity is better because daily physical activity was higher immediately after treatment. That was a secondary outcome, and the primary pain and disability outcomes showed no between-group difference at three or six months.