Trial Summary

Low back pain (LBP) is the leading musculoskeletal pain condition and a key source of medical costs and disability. An estimated 20% of adults in the United States have LBP; 50% to 80% report having a significant episode in their lifetime, and 23% experience disabling pain. LBP affects more than 31 million people in the United States at any given time, has increased threefold in prevalence in a 10-year period, and results in $100 billion to $200 billion per year in total healthcare costs. LBP is one of the leading causes of ambulatory care visits to physicians. These visits often result in treatments such as opioids that can lead to more harm than benefit. In 2017, the American College of Physicians (ACP) guideline for LBP recommended patients receive nonpharmacological interventions as a first-line treatment.

One solution that has been described in the literature but not yet tested is the primary spine practitioner (PSP) model. The PSP model involves multidisciplinary collaborative care that includes doctors of chiropractic and physical therapists—clinicians who have specific expertise in the treatment of musculoskeletal conditions—as first-line providers for LBP. These clinicians routinely employ many of the nonpharmacological approaches recommended by the ACP guideline, including spinal manipulation and exercise.

IMPACt-LBP is a pragmatic, multisite, 2-arm cluster randomized trial that will evaluate the effect of first-contact patient referral to physical therapists and doctors of chiropractic. This study aims to determine if initial contact with these PSP clinicians will improve physical function, decrease pain, decrease opioid prescriptions, improve patient satisfaction, and decrease costs and utilization of health care services in patients with a primary complaint of LBP, when compared with usual medical care.

NIH Project Information