One hundred eighty-four older adults with chronic low back pain were randomized to receive either hip-focused physical therapy (n=91) or spine-focused physical therapy (n=93). The primary outcomes of interest were disability measured using the Quebec Back Pain Disability Scale, and physical performance using the 10-Meter Walk Test at 8 weeks. Secondary outcomes of interest included the 6-minute walk test, 20-second chair stand, Timed Up and Go (TUG) test, Research Task Force Impact Score (RTF), Patient-Reported Outcomes Measurement Information System (PROMIS), lower back and hip/thigh pain intensity, post-performance movement-evoked pain aggregate, and the incidence of adverse events. Outcomes were assessed at 8 weeks and 6 months. Overall, the results of the study revealed that hip-focused physical therapy showed greater improvements in low back pain-related disability at 8 weeks but the results were not statistically different between the two groups. Both treatments yielded clinically meaningful improvements in disability and function for this high-risk population at 6 months. These findings suggest that while both approaches are beneficial, hip-focused therapy may offer quicker improvements in disability, warranting further investigation before clinical implementation.