The findings are important, as they highlight the value of chiropractors and other clinicians using structured, intentional support for better self‑management as an integrated part of treatment. The study, which included 1,000 patients randomized into four arms, is published in the journal of the American Medical Association and funded by the U.S. government.
Key Findings
The study showed that structured and individualized clinician‑supported self‑management resulted in a statistically significant reduction in disability over 12 months compared with medical treatment. The combination of clinician‑supported self‑management and manual spinal treatment produced a similar improvement, but manual treatment alone was no more effective than medical treatment—neither for disability nor pain intensity.
The self‑management groups had the highest proportion of patients experiencing more than 50% improvement in back‑related function (67% vs. 54% for medical care). There were no significant differences in pain reduction between the groups. The self-management and manual spinal treatment groups had lower back-related medication use during post-treatment follow up than the medical care group.
What Does This Mean for Chiropractors?
The study reinforces the value of focusing on supported self‑management, where the patient plays an active role in their own care. Manual spinal treatment on its own does not appear to produce better outcomes than guideline‑based medical treatment. However, combining it with structured self‑management seems to be the most effective strategy for patients at increased risk of chronic pain.
Important Context About the Study
The U.S. trial does not test chiropractic treatment as such but instead compares different clinical approaches. Nonetheless, the combination of patient education, supported self‑management, and (optional) manual treatment is already implemented in the Danish chiropractic agreement and is an integrated part of the chiropractic education at the University of Southern Denmark. The findings also align closely with the Region of Southern Denmark’s Back Care Pathway.
Gert Bronfort, Eric N. Meier, Brent Leiniger et al. Spinal Manipulation and Clinician-Supported Biopsychosocial Self-Management for Acute Back PainThe PACBACK Randomized Clinical Trial. JAMA 2025.
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