Effectiveness of Nonpharmacologic Treatments for Chronic Low Back Pain : A Sequential, Multiple-Assignment, Randomized Trial.

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Riassunto dello studio

749 adults with chronic low back pain were randomized to receive 8 weeks of physical therapy (PT) or cognitive behavioral therapy (CBT). Participants who did not achieve at least a 50% improvement in Oswestry Disability Index (ODI) score were randomized again to mindfulness or switching to the alternative initial treatment. The primary outcomes were low back pain-related function measured using the ODI and pain intensity measured using a numerical rating scale. Secondary outcomes included Patient-Reported Outcomes Measurement Information System (PROMIS) health domains, opioid use, healthcare utilization, treatment response, and adverse events. Outcomes were assessed at 10, 26, and 52 weeks. Overall, PT produced a statistically greater improvement in function than CBT at 10 weeks, although the difference was smaller than the minimum important difference, and pain improvement was similar. Among initial nonresponders, mindfulness and switching treatments produced comparable function and pain outcomes at 52 weeks, supporting PT as a reasonable first-line option without demonstrating a clearly superior second-stage strategy.