In this secondary analysis, our of two hundred and ninty patients with low back pain (LBP) two hundred and fifty nine were analyzed after randomization, to risk-stratified, psychologically-informed physical therapy (n=129) or usual care (n=130). The primary outcome was pain beliefs at 6 weeks assessed by the revised Neurophysiology of Pain Questionnaire (rNPQ, knowledge) and the Survey of Pain Attitudes—harm subscale (SOPA-h, attitudes). The secondary outcome was pain-related psychological distress quantified by OSPRO-Yellow Flags (count of “yellow flags” across 11 constructs). Outcomes were assessed at baseline and 6 weeks using adjusted models. Overall, the results revealed small but statistically significant improvements in rNPQ and reductions in OSPRO yellow-flag count with risk-stratified care versus usual care, while SOPA-h did not differ. In short, immediate post-treatment changes favored risk-stratified care for knowledge and distress, suggesting early cognitive-affective benefits that may mediate later clinical outcomes.