437 Uncertain effectiveness of physical conditioning to reduce sickness absence for back pain

July 14, 2014

PEARLS 437, July 2014, written by Brian R McAvoy.

Clinical question
How effective is physical conditioning as part of a return-to-work strategy in reducing time lost from work and improving work status for workers with back pain?

Bottom line
For workers with acute back pain (symptoms <6 weeks), physical conditioning may have no effect on sickness absence duration. There was conflicting evidence regarding the reduction of sickness absence duration with intense physical conditioning versus usual care for workers with subacute back pain (symptoms 6–12 weeks). For workers with chronic back pain (symptoms >12 weeks), physical conditioning had a small effect on reducing sick leave compared with care as usual, after 12 months’ follow-up. Physical conditioning compared with exercise therapy showed conflicting results for workers with subacute and chronic back pain. Cognitive behavioural therapy was probably not superior to physical conditioning as an alternative, or in addition, to physical conditioning.

Caveat
The quality of the evidence ranged from very low to moderate. Although 16 of the included studies were well designed and had no major flaws, some studies were poorly conducted, and the small number of participants in most studies lowered the overall quality of the evidence.

Context
Physical conditioning, as part of a return-to-work strategy, aims to improve work status for workers on sick leave due to back pain. The exercises or tasks are structured and progressively graded to increase psychological, physical and emotional tolerance and to improve endurance and work feasibility. In such environments, injured workers improve their general physical condition through an exercise programme aimed at increasing strength, endurance, flexibility and cardiovascular fitness.

Cochrane Systematic Review
Schaafsma FG et al. Physical conditioning as part of a return to work strategy to reduce sickness absence for workers with back pain. Cochrane Reviews, 2013, Issue 8. Art. No.: CD001822.DOI: 10.1002/14651858. CD001822.pub3. This review contains 25 studies involving 4404 participants.

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.