Effect of a Biopsychosocial Intervention or Postural Therapy on Disability and Health Care Spending Among Patients With Acute and Subacute Spine Pain: The SPINE CARE Randomized Clinical Trial.

Journal Article (Journal Article;Multicenter Study)

IMPORTANCE: Low back and neck pain are often self-limited, but health care spending remains high. OBJECTIVE: To evaluate the effects of 2 interventions that emphasize noninvasive care for spine pain. DESIGN, SETTING, AND PARTICIPANTS: Pragmatic, cluster, randomized clinical trial conducted at 33 centers in the US that enrolled 2971 participants with neck or back pain of 3 months' duration or less (enrollment, June 2017 to March 2020; final follow-up, March 2021). INTERVENTIONS: Participants were randomized at the clinic-level to (1) usual care (n = 992); (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 = 829); or (3) individualized postural therapy (IPT), a postural therapy approach that combines physical therapy with building self-efficacy and self-management (n = 1150). MAIN OUTCOMES AND MEASURES: 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. RESULTS: 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 -5.8 (95% CI, -7.7 to -3.9; P < .001) for ICE and -4.3 (95% CI, -5.9 to -2.6; P < .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 -$139 (risk ratio, 0.93 [95% CI, 0.87 to 0.997]; P = .04) for ICE and $941 (risk ratio, 1.40 [95% CI, 1.35 to 1.45]; P < .001) for IPT. CONCLUSIONS AND RELEVANCE: 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. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03083886.

Full Text

Duke Authors

Cited Authors

  • Choudhry, NK; Fifer, S; Fontanet, CP; Archer, KR; Sears, E; Bhatkhande, G; Haff, N; Ghazinouri, R; Coronado, RA; Schneider, BJ; Butterworth, SW; Deogun, H; Cooper, A; Hsu, E; Block, S; Davidson, CA; Shackelford, CE; Goyal, P; Milstein, A; SPINE CARE Investigators, ; Crum, K; Scott, J; Marton, K; Silva, FM; Obeidalla, S; Robinette, PE; Lorenzana-DeWitt, M; Bair, CA; Sadun, HJ; Goldfield, N; Hogewood, LM; Sterling, EK; Pickney, C; Koltun-Baker, EJ; Swehla, A; Ravikumar, V; Malhotra, S; Finney, ST; Holliday, L; Moolman, KC; Coleman-Dockery, S; Patel, IB; Angel, FB; Green, JK; Mitchell, K; McBean, MR; Ghaffar, M; Ermini, SR; Carr, AL; MacDonald, J

Published Date

  • December 20, 2022

Published In

Volume / Issue

  • 328 / 23

Start / End Page

  • 2334 - 2344

PubMed ID

  • 36538309

Pubmed Central ID

  • PMC9856689

Electronic International Standard Serial Number (EISSN)

  • 1538-3598

Digital Object Identifier (DOI)

  • 10.1001/jama.2022.22625


  • eng

Conference Location

  • United States