Table 1 Exclusion Criteria

Previous lumbar spine surgery

Planning on surgical consult or seeking elective spine surgery within the next 6 months

Back-related visit or procedure in prior 6 months (exception: Primary care settings)

Planning on moving out of area or leaving Health System within the next 12 months

Major medical problems or planned surgeries that would prevent you from being in the study for the next 12 months

Inflammatory spondyloarthropathy

Suspected spinal malignancy or infection at index visit

Developmental spine deformities (e.g. spina bifida or tethered cord)

Vascular claudication

Severe vascular, pulmonary, or coronary artery disease which limits ambulation; including recent myocardial infarction (within 6

months)

Trauma or joint replacement in past 12 month that continues to limit ambulation

Severe osteoporosis as defined by at least one compression fractures

History of cancer within past 5 years, excluding non-melanomatous skin cancer

Severe cognitive impairment that would interfere with answering questions (assessed by Six-Item Cognitive Screening Questionnaire)