BACKGROUND: Low back pain (LBP) is prevalent, costly and disabling. A biopsychosocial treatment approach involving physical and cognitive behavioural therapy (CBT) is recommended for those with chronic LBP. It is not known if online psychological coaching tools might have a role in the secondary prevention of LBP related disability. To assess the effectiveness of an internet-delivered psychological program (MoodGYM) in addition to standard physical treatment in patients with chronic non-specific LBP at medium risk of ongoing disability. METHODS: A multisite randomized controlled trial was conducted with 108 participants (aged mean 50.4 +/- 13.6 years) with chronic LBP attending one of six private physiotherapy or chiropractic clinics. Disability (Roland Morris Disability Questionnaire) and self-efficacy (Patient Self-Efficacy Questionnaire), were assessed at baseline, post-treatment (8-weeks) with follow-up at six- and twelve-months. Participants were randomized into either the intervention group, MoodGYM plus physical treatments, or the control group which received physical treatments alone. RESULTS: No statistically significant between group differences were observed for either disability at post-treatment (effect size (standardised mean difference) 95% CI) RMD -0.06 (-0.45 to 0.31), 6-months RMD 0.01 (-0.38 to 0.39) and 12-months -0.20 (-0.62 to 0.17) or self-efficacy at post-treatment PSEQ 0.06 (-0.31 to 0.45), 6-months 0.02 (-0.36 to 0.41) and 12-months 0.21 (-0.16 to 0.63). CONCLUSION: There was no additional benefit of an internet-delivered CBT program (MoodGYM) to physical treatments in those with chronic non-specific LBP at medium risk of ongoing disability measured at post-treatment, or at 6 and 12 months. TRIAL REGISTRATION: This trial was prospectively registered with Australian New Zealand Clinical Trials Registry Number (ACTRN) 12615000269538.

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