Targeted Interventions to Prevent Chronic Low Back Pain in High Risk Patients

Low back pain (LBP) is a common problem among US adults. Initial episodes tend to be
self-limited ("acute"), but some people can progress to a state of persistent pain. Often
termed "chronic" LBP (cLBP), this condition can cause prolonged difficulty with most daily
activities, including job performance. Most patients see chiropractors or primary care
physicians (PCPs) for initial episodes of LBP. This study will compare two approaches for
preventing patients with acute LBP (aLBP) from developing cLBP. Both treatments can be
delivered in an outpatient PCP setting. The first approach is to provide PCPs with
information regarding a patient's risk of transitioning from aLBP to cLBP and to encourage
PCPs to treat patients according to accepted clinical guidelines. The second approach is to
provide the same risk information and have PCPs team up with physical therapists to deliver
psychologically-informed physical therapy (PIPT) for those patients determined to be at high
risk for transitioning to cLBP. PIPT is designed to help patients identify and overcome
physical and psychological barriers to recovery. The 1,860 patients expected to be recruited
from five regional sites (Pittsburgh, Pennsylvania; Boston, Massachusetts; Baltimore,
Maryland; Charleston, South Carolina; and Salt Lake City, Utah) will start the study when
their LBP is in an acute phase. The study's primary aims are to compare the proportions of
cLBP and measures of functional ability between the two groups at 6 months. Secondary aims
are to measure the number of LBP-related x-rays, MRIs, surgeries, and other medical
procedures during a 12-month follow-up period. The same outcomes will be assessed for an
observational cohort of 6,900 patients with aLBP at low to medium risk for transitioning to
cLBP across the 5 sites. This study was designed with input from a variety of national and
local stakeholders, including patients with LBP, providers, payers, professional
organizations, purchasers, and policy representatives.