ArticlePain medicine (Malden, Mass.)2020
A Sequential Multiple-Assignment Randomized Trial (SMART) for Stepped Care Management of Low Back Pain in the Military Health System: A Trial Protocol.
Article in Pain medicine (Malden, Mass.), 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 15 papers, 2 of them syntheses that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
15 citing papers in PubMed, 2 syntheses or guidelines pooled it, 34 citations in OpenAlex.
- Models of care for managing non-specific low back pain.The Cochrane database of systematic reviews · 2025Pooled it
- The use of sequential multiple assignment randomized trials (SMARTs) in physical activity interventions: a systematic review.BMC medical research methodology · 2024Pooled it
- Booster session prescription and outcomes in adults with chronic low back pain: Secondary analysis of a randomized clinical trial.Journal of back and musculoskeletal rehabilitation · 2026Trial
- The Adaptive Physical Activity Study in Stroke (TAPAS): A Feasibility Sequential Multiple Assignment Randomized Trial.Advanced science (Weinheim, Baden-Wurttemberg, Germany) · 2026Trial
- Partner engagement for planning and development of non-pharmacological care pathways in the AIM-Back trial.Clinical trials (London, England) · 2023Trial
- Management of U.S. Veterans presenting with axial spondyloarthritis to a chiropractic clinic: a case series.The Journal of the Canadian Chiropractic Association · 2026Article
- A review of use of external data and update on reporting standards in Sequential Multiple-Assignment Randomised Trials.Clinical trials (London, England) · 2026Review
- Optimizing diversity, equity and inclusion in pragmatic clinical trials: Findings from the Pain Management Collaboratory.The journal of pain · 2025Article
- Adapting to change: experiences and recommendations from the Pain Management Collaboratory on modifying statistical analysis plans.Pain medicine (Malden, Mass.) · 2024Article
- Utility of the PICOTS framework to assess clinical trial disruptions: monitoring the impact of COVID-19 in the Pain Management Collaboratory.Pain medicine (Malden, Mass.) · 2024Article
- Recommendations for monitoring adherence and fidelity in pragmatic trials based on experience in the Pain Management Collaboratory.Pain medicine (Malden, Mass.) · 2024Article
- Intervention Fidelity in Pain Pragmatic Trials for Nonpharmacologic Pain Management: Nuanced Considerations for Determining PRECIS-2 Flexibility in Delivery and Adherence.The journal of pain · 2023Article
- Comparative effectiveness of electroacupuncture VS neuromuscular electrical stimulation in the treatment of chronic low back pain in active-duty personals: A single-center, randomized control study.Frontiers in neurology · 2022Article
- Move to health-a holistic approach to the management of chronic low back pain: an intervention and implementation protocol developed for a pragmatic clinical trial.Journal of translational medicine · 2021Article
- Perception of lower back pain associated with use of body armor in police officers of the countryside specialized battalion of Ceará, Brazil.Revista brasileira de medicina do trabalho : publicacao oficial da Associacao Nacional de Medicina do Trabalho-ANAMTArticle
Corrections and comments
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Authors and funding
9 authors at 5 institutions in 1 country.
Funding
Abstract
backgroundThe Defense Health Agency has prioritized system-level pain management initiatives within the Military Health System (MHS), with low back pain as one of the key focus areas. A stepped care model focused on nonpharmacologic treatment to promote self-management is recommended. Implementation of stepped care is complicated by lack of information on the most effective nonpharmacologic strategies and how to sequence and tailor the various available options. The Sequential Multiple-Assignment Randomization Trial for Low Back Pain (SMART LBP) is a multisite pragmatic trial using a SMART design to assess the effectiveness of nonpharmacologic treatments for chronic low back pain.
designThis SMART trial has two treatment phases. Participants from three military treatment facilities are randomized to 6 weeks of phase I treatment, receiving either physical therapy (PT) or Army Medicine's holistic Move2Health (M2H) program in a package specific to low back pain. Nonresponders to treatment in phase I are again randomized to phase II treatment of combined M2H + PT or mindfulness-based treatment using the Mindfulness-Oriented Recovery Enhancement (MORE) program. The primary outcome is the Patient-Reported Outcomes Measurement Information System pain interference computer-adapted test score. SUMMARY: This trial is part of an initiative funded by the National Institutes of Health, Veterans Affairs, and the Department of Defense to establish a national infrastructure for effective system-level management of chronic pain with a focus on nonpharmacologic treatments. The results of this study will provide important information on nonpharmacologic care for chronic LBP in the MHS embedded within a stepped care framework.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.