https://www.archives-pmr.org/article/S0003-9993(97)90235-5/pdf

Rehabilitation of the patient with chronic low back pain.

Randomized controlled trials in industrial low back pain. Part 3. Subacute/chronic pain interventions

Since their inception in the late 1970s, work-hardening and work-conditioning programs have undergone metamorphoses. They have become less distinct and now offer more diverse services. This is primarily due to the ever-changing environment of health care, and the need to adapt to new consumer needs. Insurance demands, reimbursement issues, health care service trends, the adoption of disability management practices, and employee-employer relations are just a few variables influencing the practices of work-hardening and work-conditioning programs.

Work Hardening and Work Conditioning

The purpose of this study was to evaluate the effects of how goals are established in operant, graded activity training. Consequently, five men and one woman with long-term back pain served as their own controls and each subject participated in two exercises: sit-ups and trunk extensions. In the Predetermined Condition, the goals were established, as in many programs, by the physical therapist for the entire treatment period after an examination, interview with the patient, and a baseline period of training. By contrast, in the Negotiated Condition, training goals were based on the individual subject's and the physical therapist's views as well as prior results. All subjects received both types of training programs, but the assignment of exercise type to the condition was randomized to control for possible differences inherent in the exercise itself. Results showed that every subject obtained larger improvements in the Negotiated Condition regardless of type of exercise than in the Predetermined Condition. The difference was particularly clear for four of the six subjects and the overall average improvement was more than twice as great for the Negotiated Condition (median increase = 149%) relative to the Predetermined Condition (median increase = 67%). Part of the difference appeared to be that the Negotiated Condition increased variability in results so that some subjects produced much higher increases. These data suggest that the method employed to determine the training goals in operant activities training is an important variable. This information might be utilized to enhance the effects of the program.

Rehabilitation of the patient with chronic low back pain.

Citations

Randomized controlled trials in industrial low back pain. Part 3. Subacute/chronic pain interventions

Work Hardening and Work Conditioning

Whose Goals Should Guide? A Comparison of Two Forms of Goal Formulation on Operant Activity Training

Studies in sport physical education and health 102

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