scholarly journals Commentary on “Cognitive Functional Therapy in Patients with Non‐Specific Chronic Low Back Pain”

2019 ◽  
Vol 23 (8) ◽  
pp. 1401-1402
Author(s):  
Steven Z. George
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Chronic Low Back Pain ◽  
Low Back ◽  
Functional Therapy

scholarly journals Cognitive functional therapy compared with a group-based exercise and education intervention for chronic low back pain: a multicentre randomised controlled trial (RCT)

2019 ◽  
Vol 54 (13) ◽  
pp. 782-789 ◽  
Author(s):  
Mary O'Keeffe ◽  
Peter O'Sullivan ◽  
Helen Purtill ◽  
Norma Bargary ◽  
Kieran O'Sullivan
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Randomised Controlled Trial ◽  
Chronic Low Back Pain ◽  
Group Intervention ◽  
Controlled Trial ◽  
Mean Difference ◽  
Low Back ◽  
Functional Therapy ◽  
Randomised Controlled

BackgroundOne-size-fits-all interventions reduce chronic low back pain (CLBP) a small amount. An individualised intervention called cognitive functional therapy (CFT) was superior for CLBP compared with manual therapy and exercise in one randomised controlled trial (RCT). However, systematic reviews show group interventions are as effective as one-to-one interventions for musculoskeletal pain. This RCT investigated whether a physiotherapist-delivered individualised intervention (CFT) was more effective than physiotherapist-delivered group-based exercise and education for individuals with CLBP.Methods206 adults with CLBP were randomised to either CFT (n=106) or group-based exercise and education (n=100). The length of the CFT intervention varied according to the clinical progression of participants (mean=5 treatments). The group intervention consisted of up to 6 classes (mean=4 classes) over 6–8 weeks. Primary outcomes were disability and pain intensity in the past week at 6 months and 12months postrandomisation. Analysis was by intention-to-treat using linear mixed models.ResultsCFT reduced disability more than the group intervention at 6 months (mean difference, 8.65; 95% CI 3.66 to 13.64; p=0.001), and at 12 months (mean difference, 7.02; 95% CI 2.24 to 11.80; p=0.004). There were no between-group differences observed in pain intensity at 6 months (mean difference, 0.76; 95% CI -0.02 to 1.54; p=0.056) or 12 months (mean difference, 0.65; 95% CI -0.20 to 1.50; p=0.134).ConclusionCFT reduced disability, but not pain, at 6 and 12 months compared with the group-based exercise and education intervention. Future research should examine whether the greater reduction in disability achieved by CFT renders worthwhile differences for health systems and patients.Trial registration numberClinicalTrials.gov registry (NCT02145728).

scholarly journals Examining what factors mediate treatment effect in chronic low back pain: A mediation analysis of a Cognitive Functional Therapy clinical trial

2020 ◽  
Vol 24 (9) ◽  
pp. 1765-1774 ◽  
Author(s):  
Aoife O’Neill ◽  
Kieran O’Sullivan ◽  
Peter O’Sullivan ◽  
Helen Purtill ◽  
Mary O’Keeffe
Keyword(s):  
Clinical Trial ◽  
Low Back Pain ◽  
Back Pain ◽  
Treatment Effect ◽  
Mediation Analysis ◽  
Chronic Low Back Pain ◽  
Low Back ◽  
Functional Therapy ◽  
Therapy Clinical Trial

scholarly journals Cognitive Functional Therapy for Disabling Nonspecific Chronic Low Back Pain: Multiple Case-Cohort Study

2015 ◽  
Vol 95 (11) ◽  
pp. 1478-1488 ◽  
Author(s):  
Kieran O'Sullivan ◽  
Wim Dankaerts ◽  
Leonard O'Sullivan ◽  
Peter B. O'Sullivan
Keyword(s):  
Cohort Study ◽  
Low Back Pain ◽  
Back Pain ◽  
Chronic Low Back Pain ◽  
Functional Disability ◽  
Low Back ◽  
Functional Therapy ◽  
Baseline Phase ◽  
Multiple Case

Background Multiple dimensions across the biopsychosocial spectrum are relevant in the management of nonspecific chronic low back pain (NSCLBP). Cognitive functional therapy is a behaviorally targeted intervention that combines normalization of movement and abolition of pain behaviors with cognitive reconceptualization of the NSCLBP problem while targeting psychosocial and lifestyle barriers to recovery. Objective The purpose of this study was to examine the effectiveness of cognitive functional therapy for people with disabling NSCLBP who were awaiting an appointment with a specialist medical consultant. Design A multiple case-cohort study (n=26) consisting of 3 phases (A1–B–A2) was conducted. Methods Measurement phase A1 was a baseline phase during which measurements of pain and functional disability were collected on 3 occasions over 3 months for all participants. During phase B, participants entered a cognitive functional therapy intervention program involving approximately 8 treatments over an average of 12 weeks. Finally, phase A2 was a 12-month, no-treatment follow-up period. Outcomes were analyzed using repeated-measures analysis of variance or Friedman test (with post hoc Bonferroni correction) across 7 time intervals, depending on normality of data distribution. Results Statistically significant reductions in both functional disability and pain were observed immediately postintervention and were maintained over the 12-month follow-up period. These reductions reached clinical significance for both disability and pain. Secondary psychosocial outcomes, including depression, anxiety, back beliefs, fear of physical activity, catastrophizing, and self-efficacy, were significantly improved after the intervention. Limitations The study was not a randomized controlled trial. Although primary outcome data were self-reported, the assessor was not blinded. Conclusions These promising results suggest that cognitive functional therapy should be compared with other conservative interventions for the management of disabling NSCLBP in secondary care settings in large randomized clinical trials.

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