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Patients with chronic low back pain are often referred to physical therapy (PT), but nonphysical approaches such as cognitive behavioral therapy (CBT) and mindfulness are also available in some practice settings. How do these various modalities compare with one another? And how do they work in sequence?
In this trial, 750 adults with at least 3 months of moderate to severe low back pain were randomized to either PT or CBT for 8 weeks. Those who didn’t have at least a 50% improvement in disability by 10 weeks (nonresponders) were then randomized to switch to whichever modality they didn’t receive the first time or to mindfulness, again for 8 weeks. All interventions were administered in concordance with evidence-based guidelines.