Validation of the STarT Back Screening Tool in the Primary Care Management of Low Back Pain in the Military Health System: A Randomized Trial of Risk-stratified vs. Usual Care

* "Managing Low Back Pain" pamphlet from DoD/VA * No specific guidance regarding physical therapy (PT) or other referrals, thus decision to refer or not will be made by the primary care manager (PCM) according to their preference

* "Managing Low Back Pain" pamphlet from DoD/VA * Self-management education and tools * 2-item spinal manipulation screening/delivery if indicated Low Risk: * Home Exercise Program as indicated * No referral for ongoing physical therapy Medium Risk and High Risk * Referral to physical therapy for ongoing care at physical therapists discretion * Managed by a "psychologically informed physical therapy" trained physical therapist

Physical therapists providing care will all have attended live training in PIPT principles and be involved in monthly continuing education on these principles. The use of specific principles is guided by the patient's risk stratification (as determined by the STarT Back Tool). Medium Risk: \- Reassurance will be provided to address specific concerns related to their LBP and implications on work High Risk: \- Physical therapy will be psychologically augmented with the assessment of biopsychosocial risk factors and the adoption of cognitive behavioral principles that explore patient concerns and address unhelpful beliefs and behaviors, including tailored education (e.g., stress management and pain neuroscience), graded exercise, \& graded exposure

Usual care at the general practitioner's discretion