Final Research Report

View this project's final research report.

Journal Citations

Article Highlight: This PCORI-funded study aimed to test whether a risk-stratified approach to treatment in primary care settings would result in lower rates of patients with acute back pain developing chronic back pain. To assess chronic pain risk, the team asked patients questions about how they were coping with back pain and assigned them to either low-, medium-, or high-risk groups. Patients who scored high risk were placed into two groups: usual care or usual care plus psychologically informed physical therapy, which also teaches patients coping skills to manage back pain. As reported in EClinicalMedicine, among patients at high risk, 50 percent developed chronic back pain regardless of type of care, while 20 percent of low-risk and 33 percent of medium-risk patients developed chronic low back pain.

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
Comparing Two Approaches to Prevent Long-Term Low Back Pain in High-Risk Patients -- The TARGET Trial

Key Dates

February 2015
November 2021

Study Registration Information


Has Results
Health Conditions Health Conditions These are the broad terms we use to categorize our funded research studies; specific diseases or conditions are included within the appropriate larger category. Note: not all of our funded projects focus on a single disease or condition; some touch on multiple diseases or conditions, research methods, or broader health system interventions. Such projects won’t be listed by a primary disease/condition and so won’t appear if you use this filter tool to find them. View Glossary
Populations Populations PCORI is interested in research that seeks to better understand how different clinical and health system options work for different people. These populations are frequently studied in our portfolio or identified as being of interest by our stakeholders. View Glossary
Intervention Strategy Intervention Strategies PCORI funds comparative clinical effectiveness research (CER) studies that compare two or more options or approaches to health care, or that compare different ways of delivering or receiving care. View Glossary
State State The state where the project originates, or where the primary institution or organization is located. View Glossary
Last updated: March 4, 2022