Results Summary

What was the research about?

Low back pain is a common reason people seek health care. For most, the pain is temporary. For others, the pain persists. This chronic pain causes problems with sitting, walking, working, or other activities. Some patients may be at higher risk of developing chronic pain than others.

In this study, the research team looked separately at patients with recent low back pain who had different risks for developing chronic pain. To assess chronic pain risk, the team asked patients questions about how they were coping with back pain.

For patients at high risk, the research team compared two types of care:

  • Usual care, which included home treatment such as over-the-counter pain medicine.
  • Usual care plus a referral to psychologically informed physical therapy, or PIPT. PIPT helps patients learn coping skills to manage back pain.

For patients at low or medium risk of chronic low back pain, the team looked at patients’ rates of chronic back pain six months after they received usual care.

What were the results?

Of patients at high risk, 50 percent developed chronic pain with both types of care. Level of disability and use of health care for low back pain were also similar for both types of care.

After six months, 20 percent of low-risk and 33 percent of medium-risk patients developed chronic low back pain. Also, 30 to 40 percent of low- and medium-risk patients had another doctor visit for low back pain.

For patients at all risk levels, doctors often ordered non-recommended tests and treatments, such as x-rays and opioids.

What did the research team do?

The research team assigned 76 clinics from four health systems across the United States by chance to one of the two groups. In the PIPT group, the research team asked doctors to refer high-risk patients to physical therapists trained in PIPT. In the other group, doctors provided care as usual. The team reviewed the health records of all 2,300 high-risk patients. Of these, 75 percent were White, 17 percent were Black, 4 percent were another race, and 4 percent didn’t report a race; 6 percent were Hispanic. The average age was 50, and 59 percent were women.

Next, the research team reviewed the health records of 7,247 patients at low and medium risk. Of these, 81 percent were White, 13 percent were Black, 3 percent were another race, and 3 percent didn’t report a race; 4 percent were Hispanic. The average age was 51, and 58 percent were women. The team looked at health records to determine how often low back pain turned into chronic pain. They also looked at level of disability and healthcare use.

Patients with low back pain, doctors, and insurers helped plan the study.

What were the limits of the study?

Doctors only referred 40 percent of high-risk patients to PIPT. Results may have differed if doctors had referred more patients to PIPT.

Future research could look at ways to help primary care doctors prevent chronic pain for patients with low back pain.

How can people use the results?

Doctors and patients can use these results when considering ways to treat low back pain.

Final Research Report

View this project's final research report.

Peer-Review Summary

Peer review of PCORI-funded research helps make sure the report presents complete, balanced, and useful information about the research. It also assesses how the project addressed PCORI’s Methodology Standards. During peer review, experts read a draft report of the research and provide comments about the report. These experts may include a scientist focused on the research topic, a specialist in research methods, a patient or caregiver, and a healthcare professional. These reviewers cannot have conflicts of interest with the study.

The peer reviewers point out where the draft report may need revision. For example, they may suggest ways to improve descriptions of the conduct of the study or to clarify the connection between results and conclusions. Sometimes, awardees revise their draft reports twice or more to address all of the reviewers’ comments. 

Peer reviewers commented and the researchers made changes or provided responses. Those comments and responses included the following:

  • The reviewers asked for more information on what interventions patients received during physical therapy. The researchers stated that they did not have this information because they designed the study pragmatically, focusing on training physical therapists in psychologically-informed physical therapy (PIPT), and providing a checklist to remind physical therapists about this model. Therefore, the researchers did not measure adherence to PIPT.
  • The reviewers asked whether PIPT-trained physical therapists treated any patients in the usual care group and vice versa, since physical therapists in the referral area of the intervention primary care clinics received the PIPT training but were not limited to only seeing patients from the intervention primary care clinics. The researchers acknowledged that they did not have a way to match up PIPT-trained physical therapists with intervention group patients only, nor could they check to see if these physical therapists treated any patients in the usual care group.
  • The reviewers questioned the references to the care practices in the control group as guideline-based care, given the variability of those care practices and how often the treatment for low-back pain was not in line with current care guidelines. The researchers explained that they had been encouraged to use guideline-based care to more specifically describe the expected interventions in the control group but agreed that the term usual care better described the variability of clinical practices in the control group. Although the researchers had been told that usual care would not be a specific enough comparator, the reviewers felt that usual care was an appropriate control group in a pragmatic trial.

Conflict of Interest Disclosures

Project Information

Anthony Delitto, PhD, PT, FAPTA
University of Pittsburgh
$8,818,532
10.25302/05.2021.PCS.140210867
Comparing Two Approaches to Prevent Long-Term Low Back Pain in High-Risk Patients -- The TARGET Trial

Key Dates

February 2015
November 2021
2015
2020

Study Registration Information

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Last updated: January 16, 2022