Abstract and Introduction
Abstract
Cognitive functional therapy (CFT) is a physiotherapy-led intervention that has evolved from an integration of foundational behavioral psychology and neuroscience within the physiotherapist practice directed at the multidimensional nature of chronic low back pain (CLBP). The current evidence about the comparative effectiveness of CFT for CLBP is still scarce. We aimed to investigate whether CFT is more effective than core training exercise and manual therapy (CORE-MT) in pain and disability in patients with CLBP. A total of 148 adults with CLBP were randomly assigned to receive 5 one-hour individualized sessions of either CFT (n = 74) or CORE-MT (n = 74) within a period of 8 weeks. Primary outcomes were pain intensity (numeric pain rating scale, 0–10) and disability (Oswestry Disability Index, 0–100) at 8 weeks. Patients were assessed preintervention, at 8 weeks and 6 and 12 months after the first treatment session. Altogether, 97.3% (n = 72) of patients in each intervention group completed the 8 weeks of the trial. Cognitive functional therapy was more effective than CORE-MT in disability at 8 weeks (MD = −4.75; 95% CI −8.38 to −1.11; P = 0.011, effect size= 0.55) but not in pain intensity (MD = −0.04; 95% CI −0.79 to 0.71; P = 0.916). Treatment with CFT reduced disability, but the difference was not clinically important compared with CORE-MT postintervention (short term) in patients with CLBP. There was no difference in pain intensity between interventions, and the treatment effect was not maintained in the mid-term and long-term follow-ups.
Introduction
Low back pain is the leading cause of disability with a significant social and economic impact around the world.[13,18] There is strong evidence that chronic low back pain (CLBP) is associated with a complex interaction of biopsychosocial factors.[2,3,7,16,27] Although many of these factors are potentially modifiable, most existing interventions are based on a biomedical model focusing on the structure or disease, and they do not target a patient-centered approach for each case of chronic low back pain.[24]
Cognitive functional therapy (CFT) is a physiotherapy-led intervention that has evolved from an integration of foundational behavioral psychology and neuroscience within the physiotherapist practice directed at the multidimensional nature of low back pain.[22,25] The clinical journey is adapted to the individual's profile following 3 main components: (1) making sense of pain, (2) exposure with control, and (3) lifestyle changes.[25] Vibe Fersum et al.[30,31] found that CFT was significantly more effective than the combination of manual therapy and exercise for chronic low back pain and that the reduction in disability was maintained 3 years after the beginning of the study. This study had significant methodological shortcomings regarding the failure to carry out the intention to treat analysis, high risk of attrition bias, and random error.[9,11] O'Keeffe et al.[21] found that CFT was better than group-based exercise and education for disability. However, the high risk of attrition bias and performance bias precluded the confirmation of the CFT effectiveness for disability. Ussing et al.[29] found that CFT was feasible and displayed clinically important effects for chronic low back pain in a secondary care setting. However, the participants were not randomised. Therefore, it is important to conduct clinical trials to compare CFT with other interventions but overcoming these methodological shortcomings. The present study investigated whether CFT is more effective than CORE-MT in pain and disability over the 8 weeks of treatment in patients with CLBP.
Pain. 2022;163(12):2430-2437. © 2022 Lippincott Williams & Wilkins
