Implementation of the American- College of Physicians Guideline for Low Back Pain (IMPACt-LBP):
Protocol for a Healthcare Systems Embedded Multisite Pragmatic Cluster-randomized Trialal
Implementation of the American- College of Physicians Guideline for Low Back Pain (IMPACt-LBP):
Protocol for a Healthcare Systems Embedded Multisite Pragmatic Cluster-randomized Trial
SOURCE: BMJ Open 2025 (Mar 26); 15 (3): e097133
Adam P Goode • Christine Goertz • Hrishikesh Chakraborty • Stacie A Salsbury • Samuel Broderick
Barcey T Levy • Kelley Ryan • Sharon Settles • Shoshana Hort • Rowena J Dolor, et al.
Duke University School of Medicine,
Durham, North Carolina, USA
Introduction: Low back pain (LBP) is a key source of medical costs and disability, impacting over 31 million Americans at any given time and resulting in US$100-US$200 billion per year in total healthcare costs. LBP is one of the leading causes of ambulatory care visits to US physicians; problematically, these visits often result in treatments such as opioids, surgery or advanced imaging that can lead to more harm than benefit. The American College of Physicians (ACP) Guideline for Low Back Pain recommends patients receive non-pharmacological interventions as a first-line treatment. Roadmaps exist for multidisciplinary collaborative care that include well-trained primary contact clinicians with specific expertise in the treatment of musculoskeletal conditions, such as physical therapists and doctors of chiropractic, as first-line providers for LBP. These clinicians, sometimes referred to as primary spine practitioners (PSPs) routinely employ many of the non-pharmacological approaches recommended by the ACP guideline, including spinal manipulation and exercise. Important foundational work has demonstrated that such care is feasible and safe, and results in improved physical function, less pain, fewer opioid prescriptions and reduced utilisation of healthcare services. However, this treatment approach for LBP has yet to be widely implemented or tested in a multisite clinical trial in real-world practice.
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