# SMART Stepped Care Management for Low Back Pain in Military Health System

> **NIH NIH UH3** · UTAH STATE HIGHER EDUCATION SYSTEM--UNIVERSITY OF UTAH · 2020 · $1,246,631

## Abstract

PROJECT SUMMARY
Chronic pain is a ubiquitous problem and growing concern for the Military Health System (MHS). Low back
pain (LBP) is the most common condition that leads to chronic pain. Numerous recommendations have been
made to improve care for LBP and chronic pain in the MHS, including implementation of a Stepped Care
approach. Stepped Care is a treatment process that begins with broadly accessible, less intesive interventions
that can benefit many patients. Those who do not respond to initial treatments are stepped up to more intesive
treatment. While Stepped Care is advocated for pain management, and has been beneficial for improving care in
other chronic conditions, many questions remain about which treatments to use within each Step, and the
importance of sequences of care decisions. The SMART Stepped Care Management Project will support an
innovative Sequential Multiple Randomization Trial specifically designed to address these key questions. The
Project brings together a team of researchers and clinicians from the MHS and Department of Defense along
with a strong research team at the Unversity of Utah with expertise in the planning of multi-site clinical trials,
managing and analyzing research data, and facilitating the dissemination of the results. After a Planning Phase
to finalize procedures, the SMART trial will be conducted. Patients in the MHS with chronic LBP will be
randomly assigned to either receive Physical Therapy or the holistic Move to Health intervention. After 6 weeks
we will determine patients' responsiveness to their first treatment Step. Non-responders will be re-randomized
to receive either a mindfulness-oriented treatment program or treatment from an Integrative Pain Medicine
Center. Specific Aims for the SMART trial are 1) Conduct a SMART trial comparing effectiveness and cost-
effectiveness of Step 1 and 2 treatments in a Stepped Care approach for patients with LBP in the MHS with
patient-centered and healthcare cost outcomes. Sub-aims will compare main effects of Step 1 and 2 treatment
options and the sequencing effects of different treatment combinations; and 2) Examine SMART trial results in
pre-specified sub-groups based on sex/gender, age, and pain-related co-morbidities (PTSD, sleep disturbance,
post-concussive symptoms).

## Key facts

- **NIH application ID:** 10015201
- **Project number:** 5UH3AT009763-04
- **Recipient organization:** UTAH STATE HIGHER EDUCATION SYSTEM--UNIVERSITY OF UTAH
- **Principal Investigator:** Julie M Fritz
- **Activity code:** UH3 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $1,246,631
- **Award type:** 5
- **Project period:** 2017-09-20 → 2023-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10015201

## Citation

> US National Institutes of Health, RePORTER application 10015201, SMART Stepped Care Management for Low Back Pain in Military Health System (5UH3AT009763-04). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10015201. Licensed CC0.

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