The effect of cognitive functional therapy for chronic nonspecific low back pain: a systematic review and meta-analysis

Abstract

Background To apply the Bio-Psych-Social (BPS) model into clinical practice, it is important not to focus on psychosocial domains only since biomedical factors can also contribute to chronic pain conditions. The cognitive functional therapy (CFT) is the management system based on the BPS model for chronic nonspecific low back pain (CNSLBP). Objectives This study aimed to compare CFT with the other interventions for CNSLBP regarding pain, disability/functional status, QoL and psychological factors. Design This study was a systematic review and meta-analysis of a randomised controlled trial. Method Literature Search was conducted in electronic search engines. Enrolled participants included 1) CNSLBP and 2) primary, secondary, or tertiary care patients. CFT was the interventions included. Comparisons were any types of treatment. Results Three studies met the eligibility criteria. The total number of participants was 336. For pain intensity, MD [95% CIs] was -1.38 [-2.78 − 0.02] and -1.01 [-1.92 − -0.10] at intermediate and long term for two studies, respectively. About disability/functional status, SMD [95% CIs] was -0.76 [-1.46 − -0.07] at the intermediate for three studies and MD [95% CIs] was -8.48 [-11.47 − -5.49] at long term for two studies. About fear of physical activity, MD [95% CIs] was -3.01 [-5.14 − -0.88] and -3.56 [-6.43 − -0.68] at intermediate and long term for two studies, respectively. No studies reported scores associated with QOL. All the quality of the evidence was very low. Conclusions Three studies were included and the quality of all the evidence was very low. Although the study found statistically significant differences in some measures, the effectiveness of the CFT will need to be re-evaluated in the future. Trial registration PROSPERO registration number CRD42020158182.

Individualized Cognitive Functional Therapy Compared with Conservative Treatment for Patients with Chronic Neck Pain—Study Protocol for a Single Blind Pragmatic Randomized Controlled Trial

“…CFT effectiveness has been mainly evaluated in LBP patients [ 7 , 13 , 23 , 24 ]. A recent systematic review assessed the effectiveness of CFT in LBP patients [ 7 ] and presented very low certainty favorable outcomes of the intervention on pain intensity (long-term), disability, and fear of movement.…”

“…Moreover, the chronicity of NP seems to be linked with a variety of psychological and social factors (high workload, passive coping style, stress, anxiety, depression, catastrophizing, etc.) [ 5 , 6 , 7 , 8 , 9 ].…”

“…“Lifestyle change”, “making sense of pain”, and “exposure with control” are the three indispensable components that are incorporated into the intervention and interplay with each other [ 10 , 11 ]. To illustrate, “lifestyle change” aims to promote personalized and systematic exercise, promote better nutrition, and improve sleep, leading to the adoption of a less sedentary lifestyle and managing fear, stress, and anxiety [ 6 , 7 ]. “Making sense of pain” is considered to be a reflective process based on the Pain Neuroscience Education (PNE) principles [ 12 ] while its purpose is to help patients controvert their previous beliefs and embrace a novel point of view of their pain experience.…”

“…Finally, “functional integration” intends to allow individuals to progressively return to functional activities without pain escalation and related distress. This approach challenges their fear-avoidance beliefs and utilizes experiential learning in a process of behavioral change [ 6 , 7 ]. It can be argued that most contemporary conservative treatment approaches do not address the biopsychosocial component of the condition through a behavioral, educational, and self-engaging lens.…”

Editorial: “A Touch of Physiotherapy”—The significance and meaning of touch in the practice of physiotherapy

“…In many ways, the emergence of psychologically informed therapies including cognitive functional therapy, acceptance and commitment therapy, and exercise-based rehabilitation for long-term chronic health problems, represent a tacit criticism of the manual therapies that were once the cornerstone of physiotherapy practice (19,20). This is not the first time we have seen touch-based physiotherapy go out of fashion.…”