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

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. 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. 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. 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.

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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Comments

sarah key
sarah key
November 23, 2015 at 2:21 am

Although cognitive function therapy is an imperative part of management of chronic non-specific low back pain, it leaves patients in the cold who have very manageable ‘acute’ lower back pain where there is a strong mechanical element. It’s not fashionable in these modern times to talk about mechanical back pain, but the fact remains a lot of it is – and highly suitable to hands-on mobilising. If the physiotherapy world does not provide this cure, then the oseopathic, chiropractic and even the massage professions will.
Sarah Key MVO

sarah key

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Selena Horner
Selena Horner
November 30, 2015 at 3:56 am

Hi Sarah,

You bring up a very valid point. Hopefully physiotherapists can keep in mind the difference between persistent low back pain and acute onset low back pain.

Selena Horner, PT

Kjartan Vibe Fersum

I am very glad you made that comment because it allows to bring to the attention that there is definately a place for CFT also for the acute mechanical back pain. It is a gross misunderstanding that this treatment does not allow for that. If you look at the multidimensional framework that the CFT is based on in new editon of Grieves Modern Musculosketal, you will clearly see that mechanical back pain is considered in there. The other point is that although there is a place for hands on therapy with these patients it does NOT mean you dont have to adress beliefs, coping behaviours etc. Plenty of research shows that these factors are very important as prognostic factors in the long term. The work by Artus et al also shows that natural course for ALBP seems to show equally good effect sizes as most interventions in the early stage so not so sure about the importance of hands on early on.

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