The RCGP - Clinical and Special Projects, Clinical Guidelines, Acute Low Back Pain. Contents, Index page


Table 3

Evidence table of randomised controlled trials of advice on activity for acute and sub-acute LBP

Study n Patients Setting Treatment (t) Controls (c) Outcomes Results
Lindequist et al 1984 56 acute LBP +/- referred leg pain family practice Sweden Back school, physio training program, encourage phys activity despite LBP analgesics PRN advice not to strain back initial pain recovery 1 year sick leave pt satisfaction with treatment NS dif initial pain recovery or time off work further 1 yr work oss: t 16% av 44 days, c 31% av 42 days NS t more satisfied p <.05
Fordyce et al 1986 107 acute LBP (1-10 days) family practice, emergency room, ortho OP U.S. time-contingent analgesics and programmed restoration of activity traditional analgesics as required, 'let pain be your guide' 1 yr claimed impairment (C1), activity level, sickness' & health care use (HCU) NS difs at 6/52 1 yr C1 t return to normal, c increased p <.05 NS dif activity levels c more 'sick' at 9-12 months p < .05 1 yr HCU: t fell c increased p < .01
Philips et al 1991 117 acute LBP first episode <15 days family practice or emergency room Canada Graded reactivation +/- behavioural counselling Normal 'let pain guide' return to normal (factorial design) pain at 6/12 (no rating of severity or disability) exercise level NS dif pain at 6/12 begin exer by 3 days: t 86% c 55% p <.01
Lindstrom et al 1992a&b 103 sub-acute LBP 8-12/52 industrial blue collar workers Sweden graded activity prog, work-place behav principles tradit med care by own physician pain, disab, mobility, strength fitness, work loss NS dif pain, 1 yr disab p<.01 t better 1 yr mobility & fitness but NS RTW t 10 weeks c 15.1 weeks p .01 work loss in second FU year- t 12.1 weeks c 19.6 weeks p .05
Linton et al 1993 198 acute back & neck pain a) PH back pain b) first attack primary care & occup health Sweden 'early activation' einforce healthy behav, maintain daily activities, training 'treatment as usual' analgesics, rest & sick leave pain disability, satisfaction, 1 year sick leave a) NS difs b) NS difs pain or disab t more satisfied p <.05 t signif less sick-listing t 8 X less likely to devel chronic sick leave (> 200 days)
Malmivaara et al 1995 186 acute LBP (av 5 days) occupational health clinics Finland Ordinary Activity' avoid bed rest continue routine activ as normally as pos c1 back mobilising exer c2, 2 days bed rest 3 & 12/52 pain, disability lumbar flexion and days off work t significantly fewer days and ess severe pain, ess disability, fewer days off work, lowest costs
Wilkinson 1995 42 acute LBP (<7 days) family practice UK Stay mobile and no daytime rest 48 hours strict bed rest 7 & 28 days pain, disability, lumbar flexion & SLR t tended to earlier recovery but no significant differences
Indahl et al 1995 975 LBP off work 8 weeks population based (Nat insur claims) Norway Intense personal advice, reduce fear, activity, normal walking, reduce sick 'conventional medical system' return to work still on sick leave at 200 days t 30% c 60% p <.001

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