In this sequential, multiple-assignment randomized trial of 749 adults with chronic low back pain, initial treatment with physical therapy resulted in a small but statistically significant improvement in function compared with cognitive behavioral therapy at 10 weeks, although the difference did not reach the minimum clinically important threshold and pain outcomes were similar. Among nonresponders, second-stage strategies (switching therapies vs mindfulness) showed no meaningful differences in function or pain through 52 weeks, supporting physical therapy as a reasonable first-line nonpharmacologic approach.

Source: Annals of Internal Medicine