Template for Intervention Description and Replication Recommended Reporting Elements Describing Intervention of the Trial
low back pain, Pain, groupSame, pain, lower back pain
 All groupsEvidence-based assessment of low back pain according to current clinical practice guidelines, including the limited use of imaging except for patients with red flagsEnhanced active management advice emphasizing positive messages about activity, pain relief, and work for lower back painReassurance to address specific concerns related to their lower back pain and implications on workA copy of the  Low-risk groupThe aforementioned items with a 2-item spinal manipulation screening, with spinal manipulation delivered in primary care if indicatedNo referral for ongoing physical therapy Medium-risk groupSame as low-risk group with referral for ongoing physical therapy based on the Treatment Based Classification principles for up to 8 visits, 30-60–minute sessions (twice weekly) High-risk groupSame as low- and medium-risk groups, and patient is referred for ongoing physical therapy using Treatment Based Classification principles for up to 12 visits, 45-60–minute sessions (twice weekly)Physical therapy is psychologically augmented with the assessment of biopsychosocial risk factors and the adoption of cognitive behavioral principles that explore patient concerns and address unhelpful beliefs and behaviors. These strategies include tailored education, graded exercise, graded exposure, among others. Details of the content of the psychologically informed physical therapy are available elsewhereAbbreviation: STarT Back, Subgroups of Targeted Treatment for Back Pain.This table provides details for the risk-stratified care based on guidance from the Template for Intervention Description and Replication checklist. Details of usual care are listed in eTable 6 in Klaber Moffett et al,Spinal manipulation described in Fritz et al,Treatment Based Classification described in Delitto et al,