Cognitive functional therapy in patients with non‐specific chronic low back pain—a randomized controlled trial 3‐year follow‐up

Abstract

Objectives

This randomized controlled trial investigated the efficacy of cognitive functional therapy (CFT) compared with manual therapy and exercise (MT‐EX) for people with non‐specific chronic low back pain (NSCLBP) at 3‐year follow‐up.

Methods

Hundred and twenty‐one patients were randomized to CFT (n = 62) or MT‐EX (n = 59). Three‐year data were available for 30 (48.4%) participants in the CFT group, and 33 (55.9%) participants in the MT‐EX group. The primary outcomes were disability (Oswestry disability Index [ODI]) and pain intensity (numerical rating scale) and secondary outcomes were anxiety/depression (Hopkins Symptoms Checklist) and pain‐related fear (Fear‐Avoidance Belief Questionnaire). A full intention to treat analysis was conducted using linear mixed models.

Results

Significantly greater reductions in disability were observed for the CFT group, with ODI scores at 3 years 6.6 points lower in the CFT than the MT‐EX group (95%CI:‐10.1 to −3.1, p < 0.001, standardized effect size = 0.70). There was no significant difference in pain intensity between the groups at 3 years (0.6 points 95%CI:‐1.4–0.3, p = 0.195). Significantly greater reductions were also observed for the CFT group for Hopkins Symptoms Checklist and Fear‐Avoidance Belief Questionnaire (Work).

Conclusions

CFT is more effective at reducing disability, depression/anxiety and pain‐related fear, but not pain, at 3‐year follow‐up than MT‐EX.

Significance

Cognitive functional therapy (CFT) was more effective than manual therapy and exercise (MT‐EX) in reducing disability at 3‐year follow‐up, in people with non‐specific chronic low back pain. The sustained reduction in disability without concomitant reductions in pain intensity in the CFT group suggests a de‐coupling of the pain—disability relationship.

CFT resulted in long‐lasting reductions in anxiety and depression, and pain‐related fear regarding work compared to MT‐EX. The findings support the long‐term benefits of a individualized behaviourally orientated intervention that targets pain beliefs, functional restoration and lifestyle factors.

from Wiley: European Journal of Pain: Table of Contents https://ift.tt/344Guso
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