{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T06:24:06Z","timestamp":1792650246425,"version":"4.5.0"},"reference-count":61,"publisher":"American Medical Association (AMA)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA"],"published-print":{"date-parts":[[2026,2,10]]},"abstract":"\n Importance<\/jats:title>\n Low back pain (LBP) is influenced by interrelated physical, psychological, and social factors. However, most treatments focus on symptom reduction without addressing the underlying biopsychosocial needs of patients.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To determine the effectiveness of spinal manipulation and clinician-supported biopsychosocial self-management vs medical care for adults with increased risk of chronic disabling LBP.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This 2\u2009\u00d7\u20092 factorial randomized clinical trial enrolled participants in 3 research clinics at the Universities of Minnesota and Pittsburgh from November 2018 to May 2023; final follow-up was in June 2024. Adults with acute or subacute LBP at moderate to high risk of chronicity based on the STarT Back tool were randomized to 1 of 4 groups, with interventions lasting up to 8 weeks. Statistical analysis was conducted from November 2024 to June 2025.<\/jats:p>\n <\/jats:sec>\n \n Interventions<\/jats:title>\n Spinal manipulation therapy (n\u2009=\u2009201), supported self-management (n\u2009=\u2009305), or combined supported self-management with spinal manipulation (n\u2009=\u2009193) compared with guideline-based medical care (n\u2009=\u2009301). Physical therapists and chiropractors provided spinal manipulation and supported self-management.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n The 2 primary outcomes averaged over a follow-up of 1 year were monthly low back disability (Roland-Morris Disability Questionnaire) and weekly pain intensity (numerical rating scale). Secondary analysis examined the proportion of participants achieving a 50% or higher reduction in the primary outcome measures.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Among the 1000 participants randomized (mean [SD] age, 47 [16] years; 58% female), 93% completed the trial. The omnibus test for differences across the 4 treatment groups was statistically significant for disability (\n P<\/jats:italic>\n \u2009=\u2009.001; supported self-management, 4.7; spinal manipulation, 5.5; combined supported self-management with spinal manipulation, 4.8; medical care, 5.9) but not pain intensity (\n P<\/jats:italic>\n \u2009=\u2009.16; supported self-management, 2.8; spinal manipulation, 3.0; combined supported self-management with spinal manipulation, 2.8; medical care, 3.0). Averaged over 12 months, LBP disability was significantly lower compared with medical care for supported self-management (mean difference, \u22121.2 [95% CI, \u22121.9 to \u22120.5]) and supported self-management with spinal manipulation (mean difference, \u22121.1 [95% CI, \u22121.9 to \u22120.3]) but not spinal manipulation alone (mean difference, \u22120.4 [95% CI, \u22121.2 to 0.4]). Group differences in pain intensity were not statistically significant; point estimates ranged from \u22120.2 to 0. Both supported self-management groups had higher proportions of patients achieving a 50% or greater reduction in disability (supported self-management, 67%; spinal manipulation, 54%; combined supported self-management with spinal manipulation, 65%; medical care, 54%).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n For patients with acute or subacute LBP at increased risk of chronic disabling LBP, clinician-supported biopsychosocial self-management showed statistically significant but small reductions in disability, but not pain, vs medical care over 1-year follow-up, and spinal manipulation alone showed no significant difference for either outcome.<\/jats:p>\n <\/jats:sec>\n \n Trial Registration<\/jats:title>\n \n ClinicalTrials.gov Identifier:\n NCT03581123<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jama.2025.21990","type":"journal-article","created":{"date-parts":[[2025,12,29]],"date-time":"2025-12-29T16:30:43Z","timestamp":1767025843000},"page":"497","source":"Crossref","is-referenced-by-count":13,"title":["Spinal Manipulation and Clinician-Supported Biopsychosocial Self-Management for Acute Back Pain"],"prefix":"10.1001","volume":"335","author":[{"given":"Gert","family":"Bronfort","sequence":"first","affiliation":[{"name":"Integrative Health and Wellbeing Research Program, Earl E. 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Bakken Center for Spirituality & Healing, University of Minnesota, Minneapolis"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christine","family":"McFarland","sequence":"additional","affiliation":[{"name":"School of Health and Rehabilitation Sciences, Doctor of Chiropractic Program, University of Pittsburgh, Pittsburgh, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roger","family":"Chou","sequence":"additional","affiliation":[{"name":"School of Medicine, Division of General Internal Medicine, Oregon Health & Science University, Portland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Connett","sequence":"additional","affiliation":[{"name":"School of Public Health, Division of Biostatistics, University of Minnesota, Minneapolis"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony","family":"Delitto","sequence":"additional","affiliation":[{"name":"School of Health and Rehabilitation Sciences, Department of Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven Z.","family":"George","sequence":"additional","affiliation":[{"name":"School of Medicine, Department of Orthopaedic Surgery, Duke University, Durham, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ronald M.","family":"Glick","sequence":"additional","affiliation":[{"name":"School of Medicine, Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francis","family":"Keefe","sequence":"additional","affiliation":[{"name":"Pain Prevention and Management Research Program, Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Licciardone","sequence":"additional","affiliation":[{"name":"Health Science Center, University of North Texas, Fort Worth"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Craig","family":"Schulz","sequence":"additional","affiliation":[{"name":"Integrative Health and Wellbeing Research Program, Earl E. 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