Resolve Trial Tests Guideline-Informed Physical Therapy for Low Back Pain

Key Takeaways

• The post-training CPG+PIPT period was associated with fewer opioid prescriptions over 12 months.
• ODI and DVPRS scores improved slightly more over time during the CPG+PIPT period, but differences were not clinically meaningful at 6 and 12 weeks.
• The study used a multisite stepped-wedge cluster-randomized design in military and veteran care, with therapist training and monthly feedback reports.

Implementing guideline-concordant, psychologically informed physical therapy in military and veteran outpatient rehabilitation settings was associated with a 30% reduction in opioid prescriptions during the 12 months after the index visit.

The trial took place across military and veteran health care outpatient rehabilitation clinics. The analysis included 2,320 patients receiving low back pain care from 74 physical therapists working in 6 clinics. Patients were observed during usual care, training, and post-training CPG+PIPT periods within the stepped rollout. Clinics crossed from earlier care phases into the implementation phase over time rather than switching simultaneously. Physical therapists received CPG+PIPT training and monthly feedback reports summarizing practice patterns and patient outcomes. The stepped rollout allowed comparisons of symptoms during care and low back pain-related utilization after visits.

The primary outcomes were the Oswestry Disability Index and Defense and Veterans Pain Rating Scale. These measures were the main indicators of disability and pain during rehabilitation. Investigators collected them at intake and at regular intervals throughout treatment. Linear mixed models compared changes in disability and pain across the study periods. Patients entering care reported moderate disability and pain, and those levels persisted through follow-up despite slightly greater improvement over time during the CPG+PIPT period. The symptom differences were not clinically meaningful at 6 and 12 weeks.

The utilization analysis examined opioid prescriptions, spinal injections, specialty care visits, hospitalizations, imaging, and physical therapist treatment use during the year after the index visit. Utilization data came from medical databases 12 months after the index visit, and generalized linear mixed models were used for those comparisons. The post-training CPG+PIPT period was associated with a 30% reduction in opioid prescriptions over 12 months. Other low back pain-related encounters and physical therapist treatments were similar across periods.

Investigators concluded that these differences did not translate into clinically meaningful improvement, reflecting the complexity of implementing high-value low back pain management in military and veteran settings.