Spinal Manipulation and Clinician-Supported Self-Management for Preventing Chronic Low Back Pain Impact: The PACBACK Randomized Clinical Trial.

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Study Summary

1000 patients with acute or subacute low back pain (LBP) at moderate to high risk of developing chronic pain were randomized to receive clinician-supported self-management (SSM), spinal manipulation therapy (SMT), combined SSM and SMT, or guideline-based medical care (MC). The primary outcome of interest was LBP impact, measured using the National Institutes of Health (NIH) Task Force chronic LBP impact score, averaged over months 10 to 12. Secondary outcomes included chronic pain development, pain interference with daily activities, healthcare and medication use, work productivity, functional disability, patient satisfaction, and psychological outcomes. Outcomes were assessed up to 12 months. Overall, the results revealed that SSM, alone or combined with SMT, significantly reduced LBP impact compared with MC, although the differences were small. SMT alone did not significantly improve LBP impact, and adding SMT to SSM provided no additional benefit. These findings suggested that clinician-supported biopsychosocial self-management could help prevent chronic disabling LBP in patients at increased risk.