Cognitive Functional Therapy for People with Nonspecific Persistent Low Back Pain in a Secondary Care Setting—A Propensity Matched, Case–Control Feasibility Study

Abstract

Background Effective, inexpensive, and low-risk interventions are needed for patients with nonspecific persistent low back pain (NS-PLBP) who are unresponsive to primary care interventions. Cognitive functional therapy (CFT) is a multidimensional behavioral self-management approach that has demonstrated promising results in primary care and has not been tested in secondary care. Objective To investigate the effect of CFT and compare it with usual care for patients with NS-PLBP. Design Case–control study. Setting A secondary care spine center. Subjects Thirty-nine patients received a CFT intervention and were matched using propensity scoring to 185 control patients receiving usual care. Methods The primary outcome was Roland Morris Disability Questionnaire (0–100 scale) score. Group-level differences at six- and 12-month follow-up were estimated using mixed-effects linear regression. Results At six-month follow-up, a statistically significant and clinically relevant difference in disability favored the CFT group (–20.7, 95% confidence interval [CI] = –27.2 to –14.2, P < 0.001). Significant differences also occurred for LBP and leg pain, fear, anxiety, and catastrophizing in favor of CFT. At 12-month follow-up, the difference in disability was smaller and no longer statistically significant (–8.1, 95% CI = –17.4 to 1.2, P = 0.086). Differences in leg pain intensity and fear remained significantly in favor of CFT. Treatment satisfaction was significantly higher in the CFT group at six- (93% vs 66%) and 12-month (84% vs 52%) follow-up. Conclusions These findings support that CFT is beneficial for patients with NS-PLBP who are unresponsive to primary care interventions. Subsequent randomized controlled trials could incorporate booster sessions, which may result in larger effects at 12-month follow-up.

Pain and Disability in Low Back Pain Can be Reduced Despite No Significant Improvements in Mechanistic Pain Biomarkers

“…A significant improvement was found in pain and function in the LBP group with large effect sizes similar to what has been demonstrated previously when employing a patient-centered approach to managing LBP 15,32. Moreover, the improvement in pain and disability were noticeably better than what is considered clinically meaningful 33,34.…”

“…A significant improvement was found in pain and function in the LBP group with large effect sizes similar to what has been demonstrated previously when employing a patientcentered approach to managing LBP. 15,33 Moreover, the improvement in pain and disability were noticeably better than what is considered clinically meaningful. 34,35 However, these improvements were not aligned with changes in pain sensitivity similar to recent findings by Vaegter et al 36 Arguably, the initial symptoms, experienced immediately after the onset of clinical LBP, could reflect tissue injury.…”

From protection to non‐protection: A mixed methods study investigating movement, posture and recovery from disabling low back pain

“…Following the exclusion of specific causes of LBP, CFT targets modifiable cognitions, emotions, movements, postures and lifestyle factors identified to contribute to an individual's ongoing pain and activity limitation (O'Sullivan et al, 2018 ). CFT has shown clinically significant and sustained improvements in pain and function (O'Sullivan et al, 2015 ; Ussing et al, 2020 ; Vibe Fersum et al, 2013 ; Vibe Fersum et al, 2019 ) and is often accompanied by changes in the way people conceptualize their pain (Bunzli, McEvoy, et al, 2016 ).…”

“…CFT has shown clinically significant and sustained improvements in pain and function (O'Sullivan et al, 2015;Ussing et al, 2020;Vibe Fersum et al, 2013;Vibe Fersum et al, 2019) and is often accompanied by changes in the way people conceptualize their pain (Bunzli, McEvoy, et al, 2016). Four specially trained physiotherapists provided up to 10 sessions of funded CFT depending on the participants' clinical course.…”

Cognitive functional therapy compared with core exercise and manual therapy in patients with chronic low back pain: randomised controlled trial

“…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.…”