Key PointsQuestionIs risk-stratified care more effective than usual care for patients with low back pain seeking care in the Military Health System?FindingsIn this randomized clinical trial of 270 adults with low back pain, the risk-stratified care approach did not result in superior scores on the Roland Morris Disability Questionnaire at 1 year compared with patients who received usual care.MeaningThese findings suggest that clinicians seeing patients for low back pain in the Military Health System should be cautious about implementing this particular risk-stratified care treatment approach.