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

Mary O'Keeffe; Peter O'Sullivan; Helen Purtill; Norma Bargary; Kieran O'Sullivan

doi:10.1136/bjsports-2019-100780

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

Br J Sports Med. 2020 Jul;54(13):782-789. doi: 10.1136/bjsports-2019-100780. Epub 2019 Oct 19.

Authors

Mary O'Keeffe¹, Peter O'Sullivan^{2

3}, Helen Purtill^{4

5

6}, Norma Bargary^{4

5}, Kieran O'Sullivan^{5

6

7

8}

Affiliations

¹ Institute for Musculoskeletal Health, Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia mary.okeeffe@sydney.edu.au.
² School of Physiotherapy and Exercise Science, Curtin University, Shenton Park, Perth, Western Australia, Australia.
³ Bodylogic Physiotherapy, Perth, Western Australia, Australia.
⁴ Department of Mathematics & Statistics, Faculty of Science & Engineering, University of Limerick, Limerick, Ireland.
⁵ Health Research Institute, University of Limerick, Limerick, Ireland.
⁶ Aging Research Centre, University of Limerick, Limerick, Ireland.
⁷ Sports Spine Centre, Aspetar Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.
⁸ School of Allied Health, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland.

Abstract

Background: One-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.

Methods: 206 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.

Results: CFT 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).

Conclusion: CFT 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 number: ClinicalTrials.gov registry (NCT02145728).

Keywords: effectiveness; lower back; physiotherapy; randomised controlled trial.

Publication types

Multicenter Study
Randomized Controlled Trial

MeSH terms

Adult
Aged
Chronic Pain / psychology
Chronic Pain / therapy*
Cognitive Behavioral Therapy* / methods
Combined Modality Therapy
Exercise Therapy* / methods
Female
Humans
Intention to Treat Analysis
Low Back Pain / psychology
Low Back Pain / therapy*
Male
Middle Aged
Patient Education as Topic* / methods

Associated data

ClinicalTrials.gov/NCT02145728