Spinal Manipulation and Patient Self-Management for Preventing Acute to Chronic Back Pain

NCT ID: NCT03581123

Last Updated: 2025-10-16

Study Results

Results available

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Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

PHASE3

Total Enrollment

1000 participants

Study Classification

INTERVENTIONAL

Study Start Date

2018-11-01

Study Completion Date

2024-06-12

Brief Summary

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This is a study of adults with acute low back pain flare-up at risk of becoming chronic and disabling. The study tests how well spinal manipulation and guided selfcare work compared to standard medical care. The treatments last up to eight weeks and participants will be followed for one year.

Detailed Description

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The long-term goal is to reduce overall low back pain (LBP) burden by evaluating, first-line, non-drug treatment strategies that address the biological, psychological and social aspects of acute LBP and prevent transition to chronic back pain. The study will also assess barriers and facilitators that impact future implementation of the non-drug treatments into clinical practice.

The US faces an unprecedented pain management crisis. LBP is the most common chronic pain condition in adults and one of the leading causes of disability worldwide. Guidelines have recommended non-drug treatments like spinal manipulation and behavioral and selfcare approaches for LBP for nearly a decade, yet uptake and adherence has been poor. Little is known about the role of these treatments in the secondary prevention of chronic LBP, especially for patients at risk of developing severe low back pain. Due to high societal costs, and side effects of commonly used drug treatments, including opioids, there is a critical need for research on how well non-drug treatments work for preventing serious chronic LBP.

Conditions

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Acute Pain Low Back Pain, Mechanical

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

FACTORIAL

2x2 factorial design
Primary Study Purpose

TREATMENT

Blinding Strategy

DOUBLE

Investigators Outcome Assessors

Study Groups

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Supported-Self management (SSM)

Supported-Self management

Group Type EXPERIMENTAL

Supported-Self Management (SSM)

Intervention Type BEHAVIORAL

Provides low back pain sufferers opportunities to develop the capacity and motivation to self-manage their pain in an adaptive manner. This includes psychological/behavioral strategies, mind-body approaches, lifestyle advice, pain education and pain coping.

Spinal Manipulation Therapy (SMT)

Spinal Manipulation Therapy

Group Type EXPERIMENTAL

Spinal Manipulation Therapy (SMT)

Intervention Type OTHER

SMT will address the biological and physical aspects of low back pain (e.g. spinal dysfunction) with the intention of restoring maximum movement and functional ability of the spine.

SMT + SSM

Spinal Manipulation Therapy + Supported Self-Management

Group Type EXPERIMENTAL

SMT + SSM

Intervention Type COMBINATION_PRODUCT

Combination Treatment

Standard Medical Care (SMC)

Standard Medical Care

Group Type ACTIVE_COMPARATOR

Standard Medical Care (SMC)

Intervention Type DRUG

Guideline based medical care informed by the American College of Physicians' guidelines on noninvasive treatment for low back pain.

Interventions

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Supported-Self Management (SSM)

Provides low back pain sufferers opportunities to develop the capacity and motivation to self-manage their pain in an adaptive manner. This includes psychological/behavioral strategies, mind-body approaches, lifestyle advice, pain education and pain coping.

Intervention Type BEHAVIORAL

Spinal Manipulation Therapy (SMT)

SMT will address the biological and physical aspects of low back pain (e.g. spinal dysfunction) with the intention of restoring maximum movement and functional ability of the spine.

Intervention Type OTHER

SMT + SSM

Combination Treatment

Intervention Type COMBINATION_PRODUCT

Standard Medical Care (SMC)

Guideline based medical care informed by the American College of Physicians' guidelines on noninvasive treatment for low back pain.

Intervention Type DRUG

Eligibility Criteria

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Inclusion Criteria

* At least 18 years of age
* Acute or sub-acute low back pain
* Average low back pain severity ≥3 on the 0-10 numerical rating scale over 7 days
* Medium or high risk for persistent disabling back pain according to the STarT Back screening tool
* Ability to read and write fluently in English

Exclusion Criteria

* Non-mechanical causes of low back pain
* Contraindications to study treatments (e.g,. surgical fusion of lumbar spine)
* Active management of current episode of low back pain by another healthcare provider
* Serious co-morbid health condition that either requires medical attention or has a risk for general health decline over the next year
* Pregnancy, current or planned during study period and nursing mothers
* Inability or unwillingness to give written informed consent
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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University of Pittsburgh

OTHER

Sponsor Role collaborator

University of Washington

OTHER

Sponsor Role collaborator

University of North Texas Health Science Center

OTHER

Sponsor Role collaborator

Oregon Health and Science University

OTHER

Sponsor Role collaborator

Duke University

OTHER

Sponsor Role collaborator

University of Minnesota

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Gert Bronfort, PhD, DC

Role: PRINCIPAL_INVESTIGATOR

University of Minnesota

Locations

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University of Minnesota

Minneapolis, Minnesota, United States

Site Status

University of Pittsburgh

Pittsburgh, Pennsylvania, United States

Site Status

University of Washington

Seattle, Washington, United States

Site Status

Countries

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United States

References

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Bronfort G, Delitto A, Schneider M, Heagerty PJ, Chou R, Connett J, Evans R, George S, Glick RM, Greco C, Hanson L, Keefe F, Leininger B, Licciardone J, McFarland C, Meier E, Schulz C, Turk D. Effectiveness of spinal manipulation and biopsychosocial self-management compared to medical care for low back pain: a randomized trial study protocol. BMC Musculoskelet Disord. 2023 May 25;24(1):415. doi: 10.1186/s12891-023-06549-w.

Reference Type DERIVED
PMID: 37231386 (View on PubMed)

Bronfort G, Delitto A, Schneider M, Heagerty P, Chou R, Connett J, Evans R, George S, Glick R, Greco C, Hanson L, Keefe F, Leininger B, Licciardone J, McFarland C, Meier E, Schulz C, Turk D. Effectiveness of Spinal Manipulation and Biopsychosocial Self-Management compared to Medical Care for Low Back Pain: A Randomized Trial Study Protocol. Res Sq [Preprint]. 2023 May 3:rs.3.rs-2865633. doi: 10.21203/rs.3.rs-2865633/v1.

Reference Type DERIVED
PMID: 37205428 (View on PubMed)

Provided Documents

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Document Type: Study Protocol and Statistical Analysis Plan

View Document

Other Identifiers

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CSH-2018-26524

Identifier Type: -

Identifier Source: org_study_id

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