Article

Graded activity and graded exposure are increasingly being used in
the management of persistent low back pain; however, their effectiveness remains
poorly understood.
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. DATA SOURCES: Trials were electronically searched and rated for quality by
use of the PEDro scale (values of 0-10). STUDY SELECTION: Randomized controlled
trials of graded activity or graded exposure that included pain, disability,
global perceived effect, or work status outcomes were included in the study. DATA
EXTRACTION: Outcomes were converted to a scale from 0 to 100. Trials were pooled
with software used for preparing and maintaining Cochrane reviews. RESULTS: are
presented as weighted mean differences with 95% confidence intervals. DATA
SYNTHESIS: 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. LIMITATIONS: Limitations of this review
include the low quality of the studies, primarily those that evaluated graded
exposure; the use of various types of outome measures; and differences in the
implementation of the interventions, adding to the heterogeneity of the studies.
CONCLUSIONS: The available evidence suggests that graded activity in the short
term and intermediate term is slightly more effective than a minimal intervention
but not more effective than 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.

Langue : ANGLAIS