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Review Board approved the project. Mr Werneke and Dr Deutscher acknowledge that they are consultants of Focus On Therapeutic Outcomes, Inc (FOTO), the database management company that manages the data analyzed in the manuscript. Data documentation and analyses presented in the manuscript are part of Mr Werneke's and Dr Deutscher's regular daily work activities.

Baseline STarT psychosocial risk stratifications should be interpreted cautiously to estimate the likelihood of good or poor FS outcomes at discharge from physiotherapy practice in the US when patients are managed by clinicians credentialed in McKenzie methods. Decreased STarT risk was associated with clinically important improvements in FS outcomes scores at discharge from McKenzie directed physiotherapy care.

Objectives Graded activity and graded exposure are recommended cognitive behavioural approaches to improve function and pain outcomes for patients receiving physiotherapy for chronic nonspecific low back pain. Directional preference identified following the McKenzie method is also associated with favourable patient outcomes. Study objectives were to examine associations between graded activity and/or graded exposure, and directional preference or no directional preference combined with or without graded activity/graded exposure subgroups, and function and pain outcomes among patients with chronic nonspecific low back pain managed by clinicians credentialed in the McKenzie approach. Method Cohort study: Subjects (n = 801) with chronic nonspecific low back pain completed intake surveys, that is, the Lumbar Computer Adaptive Test measuring function and the Numeric Pain Rating Scale measuring pain, and questions addressing their demographic, lifestyle, and health status. Directional preference was determined at intake. Treatment with graded activity/graded exposure during the episode of care was recorded. Function and pain measures were repeated at discharge. Two models were developed controlling for potential confounding effects. The first model examined associations between patients receiving versus not receiving graded activity/graded exposure. The second model examined interaction effects between four combinations of directional preference and graded activity/graded exposure. Outcome measures were changes in function and pain during rehabilitation. Results Regarding the first objective, there were no clinically relevant differences between treatment versus no treatment with graded activity/graded exposure, and functional outcomes. Regarding the second objective, patients in the no‐directional preference group were more likely to see benefits from the addition of graded activity/graded exposure to their treatment groups than those with a directional preference. Conclusion Clinicians using McKenzie methods might attain improved patient functional outcomes when augmenting treatment with graded activity and/or graded exposure among patients who do not demonstrate directional preference.

Findings suggest that interventions matched to DP are effective for managing high psychological risk patients and may provide physiotherapists with an alternative treatment pathway compared to managing similar patients with cognitive-behavioural approaches. Stricter research designs are required to validate study conclusions.