Introduction
disability, LBP, Pain, Low back pain
CHRONIC PAIN, SECONDARY
Low back pain (LBP) is among the most frequent causes of medical visits, chronic pain, and lost productivity in the world and, as such, imposes a large societal burden globally.The Subgroups of Targeted Treatment for Back Pain (STarT Back) tool is the most investigated risk stratification approach for LBP.Thus, whether risk-stratified care is scalable to health systems outside the United Kingdom remains a challenge for improving LBP outcomes. Accordingly, we conducted the Validation of the STarT Back Screening Tool in the Primary Care Management of Low Back Pain in the Military Health System (V-START MHS) clinical trial. It complements existing trials of risk-stratified care by being, to our knowledge, the first in the United States to use individual randomization and to occur in a single-payer health system. The primary aim was to assess the clinical effectiveness of risk-stratified vs usual care in patients with LBP. We hypothesized larger improvements in disability for patients randomized to receive risk-stratified care. A secondary aim was to report 12-month health care utilization in each treatment group.