Risk-stratified Care Improves Pain-related Knowledge and Reduces Psychological Distress for Low Back Pain: A Secondary Analysis of a Randomized Trial.
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2025;13(20):52 Clin Orthop Relat Res . 2025 Apr 1;483(4):607-620.What this means for my practice?
Risk-stratified, psychologically-informed physical therapy yields early (6-week) gains in pain knowledge and reduces psychological distress compared with usual care, with the clearest distress benefit in medium/high-risk patients. Clinically, embedding risk stratification and targeted education/exposure strategies may improve near-term cognitive-affective drivers (e.g., catastrophizing, kinesiophobia) that can facilitate rehabilitation engagement. Limitations include the short follow-up window (6 weeks only), per-protocol secondary analysis, and limited numbers in the high-risk stratum, which together temper generalizability and prevent conclusions about longer-term disability outcomes.
Resumen del estudio
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.
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