Effectiveness of graded activity versus physiotherapy in patients with chronic nonspecific low back pain: midterm follow up results of a randomized controlled trial
Open accessAbstract
Background Low back pain (LBP) is a major health and economic problem worldwide. Graded activity and physiotherapy are commonly used interventions for nonspecific low back pain. However, there is currently little evidence to support the use of one intervention over the other in the medium-term.Objective To compare the effectiveness of graded activity exercises to physiotherapy-based exercises at mid-term (three and six months' post intervention) in patients with chronic nonspecific LBP.Methods Sixty-six patients were randomly allocated to two groups: graded activity group (n=33) and physiotherapy group (n=33). These patients received individual sessions twice a week for six weeks. Follow-up measurements were taken at three and six months. The main outcome measurements were intensity pain (Pain Numerical Rating Scale) and disability (Rolland Morris Disability Questionnaire).Results No significant differences between groups after three and six month-follow ups were observed. Both groups showed similar outcomes for pain intensity at three months [between group differences: -0.1 (95% confidence interval [CI]=-1.5 to 1.2)] and six months [0.1 (95% CI=-1.1 to 1.5)], disability at three months was [-0.6 (95% CI=-3.4 to 2.2)] and six months [0.0 (95% CI=-2.9 to 3.0)].Conclusion The results of this study suggest that graded activity and physiotherapy have similar effects in the medium-term for patients with chronic nonspecific low back pain.
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Evidence is conflicting for the effectiveness of combined psychological approaches delivered with physiotherapy care for improving health related quality of life compared with physiotherapy care alone.
“Evidence is conflicting for the effectiveness of combined psychological approaches delivered with physiotherapy care for improving health related quality of life, compared with physiotherapy care alone (ranging from no effect90 to a significant effect at short term91 or long term follow-up92 93).”
From Psychological interventions for chronic, non-specific low back pain: systematic review with network meta-analysis (2022) · cites this paper as [90]
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References 34 · Cited by 41
Research works printed but not linked: 2
- [28]de Souza F.S. Marinho Cda S. Siqueira F.B. Maher C.G. Costa L.O. Psychometric testing confirms that the Brazilian-Portuguese adaptations, the original versions of the Fear-Avoidance Beliefs Questionnaire, and the Tampa Scale of Kinesiophobia have similar measurement properties Spine (Phila Pa 1976) 33 9 2008 1028 1033 18427325
- [34]Lopez-de-Uralde-Villanueva I. Munoz-Garcia D. Gil-Martinez A. A systematic review and meta-analysis on the effectiveness of graded activity and graded exposure for chronic nonspecific low back pain Pain Med 2015 26235368
- Authors
- Magalhães, M. O., Comachio, J., Ferreira, P. H., Pappas, E., & Marques, A. P.
- Affiliations
- Universidade de São Paulo (BR)
- The University of Sydney (AU)
- Corresponding author
- Comachio, Josielli
- ORCID
- Venue
- Brazilian Journal of Physical Therapy
- Publisher
- Elsevier BV
- Published
- 2018-01
- Volume
- 22
- Issue
- 1
- Pages
- 82-91
- ISSN
- 1413-3555 (ISSN-L)
- PMC
- PMC5816082
- OpenAlex
- W2734670091
- Cited by
- 41
- References
- 34
- Citations by year
- 2026: 3 · 2025: 7 · 2024: 5 · 2023: 2 · 2022: 6 · 2021: 8 · 2020: 3 · 2019: 3 · 2018: 4
- FWCI
- 1.91
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Brazilian Journal of Physical Therapy (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Health Sciences › Medicine › Pathology and Forensic Medicine › Spine and Intervertebral Disc Pathology
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Pregnancy-related medical research
- Keywords
- chronic non-specific low back pain, graded activity, physiotherapy, exercise therapy, pain intensity, disability, mid-term follow-up, treatment effectiveness comparison
- MeSH terms
- Chronic Disease, Exercise Therapy, Follow-Up Studies, Humans, Exercise, Treatment Outcome, Low Back Pain, Physical Therapy Modalities
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