Effect of a Biopsychosocial Intervention or Postural Therapy on Disability and Health Care Spending Among Patients With Acute and Subacute Spine Pain
Authors: Choudhry Niteesh K. , Fifer Sheila , Fontanet Constance P. , Archer Kristin R. , Sears Ellen , Bhatkhande Gauri , Haff Nancy , Ghazinouri Roya , Coronado Rogelio A. , Schneider Byron J. , Butterworth Susan W. , Deogun Harvinder , Cooper Angelina , Hsu Eugene , Block Shannon , Davidson Claudia A. , Shackelford Claude E. , Goyal Parul , Milstein Arnold ,   SPINE CARE Investigators, Crum Katherine , Scott Jennifer , Marton Keith , Silva Flavio M. , Obeidalla Sarah , Robinette Payton E. , Lorenzana-DeWitt Mario , Bair Courtney A. , Sadun Hana J. , Goldfield Natalie , Hogewood Luke M. , Sterling Emma K. , Pickney Cole , Koltun-Baker Emma J. , Swehla Andrew , Ravikumar Vishvaas , Malhotra Sameeksha , Finney Sabrina T. , Holliday Lynn , Moolman Karin C. , Coleman-Dockery Shanita , Patel Ilaben B. , Angel Federica B. , Green Jennifer K. , Mitchell Kevin , McBean Mary R. , Ghaffar Muteeb , Ermini Sandra R. , Carr Ana L. , MacDonald James 
Published: December 2022

ImportanceLow back and neck pain are often self-limited, but health care spending remains high.ObjectiveTo evaluate the effects of 2 interventions that emphasize noninvasive care for spine pain.Design, Setting, and ParticipantsPragmatic, 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).InterventionsParticipants 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 MeasuresThe 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.ResultsAmong 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 &amp;lt; .001) for ICE and −4.3 (95% CI, −5.9 to −2.6; P &amp;lt; .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 &amp;lt; .001) for IPT.Conclusions and RelevanceAmong 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 RegistrationClinicalTrials.gov Identifier: NCT03083886