BACKGROUND: Non-specific low-back pain (LBP) is considered a major health and economic problem in western society. Nowadays a common used intervention on non-specific LBP is graded activity (GA). Graded activity developed by Lindstrom et al, consisted of four parts: (i) measurements of functional capacity; (ii) a work-place visit; (iii) back school education and (iv) an individual, sub-maximal, gradually increased exercise program with an operant-conditioning behavioural approach as described by Fordyce et al. OBJECTIVE: To evaluate the effectiveness of GA in adults with non-specific LBP on pain, disabilities and return to work. DATA SOURCES: An extensive literature search of PubMed, Embase, CINAHL and the Cochrane Library was conducted in July 2011. REVIEW METHODS: Randomized controlled trials (RCTs) evaluating the effect of GA in patients with non-specific LBP were eligible. Methodological quality of the studies was assessed according to the PEDro scale. A best-evidence synthesis was conducted according to van Peppen et al to interpret the outcomes of the included studies. RESULTS: Ten articles were included in this systematic review; these articles described five RCTs (680 patients). The best-evidence synthesis revealed that there was no or insufficient evidence for a positive effect of GA on pain, disabilities and return to work in patients with non-specific LBP. CONCLUSION: Currently there is no or insufficient evidence that GA results in better outcomes of patients with non-specific LBP.

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