Non-drug treatments
Advice to stay active
In this section:
Summary statement | Benefits | Harms | Comment
Summary statement
Symptom improvement
Compared with bed rest Advice to stay active is more effective at reducing pain at 3 to 12 weeks post episode (moderate-quality evidence).
Functional improvement
Compared with no advice or traditional medical treatment (including analgesics as required, advice to rest, and "let pain be your guide") Advice to stay active with or without other treatments may be more effective than traditional medical treatment alone (including analgesics as required, advice to rest, and "let pain be your guide") at reducing chronic disability at up to 1 year. However, evidence was weak and the size of effects was unclear (very low-quality evidence).
Compared with bed rest Advice to stay active is more effective at improving functional outcomes at 3 to 12 weeks post episode (moderate-quality evidence).
Return to work
Compared with no advice or traditional medical treatment (including analgesics as required, advice to rest, and "let pain be your guide") Advice to stay active with or without other treatments may be more effective than traditional medical treatment alone (including analgesics as required, advice to rest, and "let pain be your guide") at reducing sick leave. However, evidence was weak and the size of effects was unclear (very low-quality evidence).
Compared with bed rest Advice to stay active seems to be more effective than bed rest at reducing initial sick leave and sick leave at 3 to 4 weeks and 12 weeks in people with acute low back pain (moderate-quality evidence).
For GRADE evaluation of interventions for low back pain (acute), see table.
Benefits
We found one systematic review (search date 1996, 6 RCTs, 1957 people).[28]
Advice to stay active versus no advice or traditional medical treatment:
The review did not pool data, but reported consistent findings among included RCTs.[28] The review compared advice to stay active with or without other treatments versus those other treatments alone. The review found that advice to stay active significantly reduced sick leave (significance not assessed; reported as significant) and reduced chronic disability at up to 1 year compared with traditional medical treatment (including analgesics as required, advice to rest, and "let pain be your guide"). See comment.[28]
Advice to stay active versus bed rest:
Harms
Advice to stay active versus no advice or traditional medical treatment:
The review[28] gave no information on adverse effects.
Advice to stay active versus bed rest:
Comment
Limitations in methods preclude meaningful quantification of effect sizes. Advice to stay active was provided either as a single treatment or in combination with other interventions such as back schools, a graded activity programme, or behavioural counselling.
The distinction between placebo effects and specific treatment effects is often ill-defined in non-pharmaceutical treatment trials. Thus, the selection of a comparison group often requires considerable thought to ensure that the placebo intervention does not share some of the specific therapeutic components of the experimental intervention. This issue is more of a concern when placebos are designed to resemble the experimental intervention. In some placebo-controlled trials, the placebo treatment is actually used in clinical practice as a treatment.[10]
Web publication date: 9 May 2011 (based on December 2009 search)
