Testing a Personalized Approach to Chronic Low Back Pain: A Randomized Controlled Trial in Older Veterans

We aimed to test the efficacy of personalized treatment of older veterans with chronic low back pain (CLBP) delivered by Aging Back Clinics (ABCs) as compared with usual care (UC).

Two hundred ninety-nine veterans aged 65 to 89 with CLBP from three Veterans Affairs (VA) medical centers underwent baseline testing, randomization to ABC or UC, and 12 months of follow-up. ABC care was guided by trained physicians and published algorithms targeting key conditions contributing to CLBP (eg, hip osteoarthritis, depression, fibromyalgia). UC was guided by the participant's primary care provider. The primary outcome was six-month change in the Oswestry Disability Index (ODI). Among multiple secondary outcomes were pain intensity, quality of life (Patient-Reported Outcomes Measurement Information System [PROMIS]-Global Health), self-reported physical function (PROMIS-29), falls, life space, and health care utilization collected at 3, 6, 9, and 12 months. Analyses were conducted according to intention-to-treat.

There were no significant group differences in ODI change. Greater improvement with ABC in the PROMIS-29 physical function scale was observed at 12 months (1.7 vs -0.4 points), PROMIS Global physical health at 6 (1.3 vs -1.2) and 12 months (0.7 vs -1.5), PROMIS Global mental health at 6 months (0.2 vs -2.3), and present and prior week average/worst pain over 12 months (all P < 0.05). There were marginally fewer falls over 12 months (P = 0.0527).

We did not find confirmatory evidence that personalized care (ABC) was superior with respect to ODI. We did find preliminary evidence that ABC was superior in other respects including improved self-reported physical health, less pain, and fewer falls.