{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T16:52:42Z","timestamp":1793206362756,"version":"4.5.0"},"reference-count":33,"publisher":"American Medical Association (AMA)","issue":"23","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA"],"published-print":{"date-parts":[[2022,12,20]]},"abstract":"\n Importance<\/jats:title>\n Low back and neck pain are often self-limited, but health care spending remains high.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To evaluate the effects of 2 interventions that emphasize noninvasive care for spine pain.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n Pragmatic, cluster, randomized clinical trial conducted at 33 centers in the US that enrolled 2971 participants with neck or back pain of 3 months\u2019 duration or less (enrollment, June 2017 to March 2020; final follow-up, March 2021).<\/jats:p>\n <\/jats:sec>\n \n Interventions<\/jats:title>\n Participants were randomized at the clinic-level to (1) usual care (n\u2009=\u2009992); (2) a risk-stratified, multidisciplinary intervention (the identify, coordinate, and enhance [ICE] care model that combines physical therapy, health coach counseling, and consultation from a specialist in pain medicine or rehabilitation) (n\u2009=\u2009829); or (3) individualized postural therapy (IPT), a postural therapy approach that combines physical therapy with building self-efficacy and self-management (n\u2009=\u20091150).<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n The primary outcomes were change in Oswestry Disability Index (ODI) score at 3 months (range, 0 [best] to 100 [worst]; minimal clinically important difference, 6) and spine-related health care spending at 1 year. A 2-sided significance threshold of .025 was used to define statistical significance.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Among 2971 participants randomized (mean age, 51.7 years; 1792 women [60.3%]), 2733 (92%) finished the trial. Between baseline and 3-month follow-up, mean ODI scores changed from 31.2 to 15.4 for ICE, from 29.3 to 15.4 for IPT, and from 28.9 to 19.5 for usual care. At 3-month follow-up, absolute differences compared with usual care were \u22125.8 (95% CI, \u22127.7 to \u22123.9;\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001) for ICE and \u22124.3 (95% CI, \u22125.9 to \u22122.6;\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001) for IPT. Mean 12-month spending was $1448, $2528, and $1587 in the ICE, IPT, and usual care groups, respectively. Differences in spending compared with usual care were \u2212$139 (risk ratio, 0.93 [95% CI, 0.87 to 0.997];\n P<\/jats:italic>\n \u2009=\u2009.04) for ICE and $941 (risk ratio, 1.40 [95% CI, 1.35 to 1.45];\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001) for IPT.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n Among patients with acute or subacute spine pain, a multidisciplinary biopsychosocial intervention or an individualized postural therapy intervention, each compared with usual care, resulted in small but statistically significant reductions in pain-related disability at 3 months. However, compared with usual care, the biopsychosocial intervention resulted in no significant difference in spine-related health care spending and the postural therapy intervention resulted in significantly greater spine-related health care spending at 1 year.<\/jats:p>\n <\/jats:sec>\n \n Trial Registration<\/jats:title>\n \n ClinicalTrials.gov Identifier:\n NCT03083886<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jama.2022.22625","type":"journal-article","created":{"date-parts":[[2022,12,20]],"date-time":"2022-12-20T11:03:51Z","timestamp":1671534231000},"page":"2334","source":"Crossref","is-referenced-by-count":27,"title":["Effect of a Biopsychosocial Intervention or Postural Therapy on Disability and Health Care Spending Among Patients With Acute and Subacute Spine Pain"],"prefix":"10.1001","volume":"328","author":[{"given":"Niteesh K.","family":"Choudhry","sequence":"first","affiliation":[{"name":"Center for Healthcare Delivery Sciences (C4HDS), Department of 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