Integrating physical and psychological approaches to treatment in low back pain: the development and content of the STarT Back trial's ‘high-risk’ intervention (StarT Back; ISRCTN 37113406)

A new randomised controlled trial of intervention in low back pain has been described recently. In this trial, a screening and targeted approach was found to be more effective and cost-effective than current best practice. Nested within the intervention arm were three different interventions targeting patients identified as ‘low’, ‘medium’ or ‘high’ risk dependent on the presence of (mainly) psychosocial risk factors. In this paper, the development and content of the STarT Back trial's ‘high-risk’ intervention is described. It offers a systematic approach, termed ‘psychologically informed practice’, to the integration of physical and psychological approaches to treatment for the management of people with low back pain by physiotherapists. The term ‘disability’ is used to refer to self-reported pain-associated functional limitations, and ‘psychological’ is used to refer to the beliefs/expectations, emotional responses and behavioural responses associated with low back pain.