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

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

doi:10.1136/bjsports-2019-100780

Cited by 217Musculoskeletal pain and rehabilitationPain Management and TreatmentPregnancy-related medical research

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

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O'Keeffe, Mary, O'Sullivan, Peter, Purtill, Helen, Bargary, Norma, O'Sullivan, Kieran·2020·British Journal of Sports Medicine

DOI 10.1136/bjsports-2019-100780PMC PMC7361017

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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 ).

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Low back pain may be related to psychological factors such as perceptions of back pain, depression, fear of activity, and pain self-efficacy.
“In addition to the core muscles, low back pain may be related to psychological factors, such as perceptions of back pain, depression, fear of activity, and pain self-efficacy [13].”
From Effect of m-health-based core stability exercise combined with self-compassion training for patients with non-specific chronic low back pain: study protocol for a randomized controlled trial (2022) · cites this paper as [13]

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The Influence of the Locus of Control Construct on the Efficacy of Physiotherapy Treatments in Patients with Chronic Pain: A Systematic Review
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Effect of multidimensional physiotherapy on non-specific chronic low back pain: a randomized controlled trial
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Counting your chickens before they hatch: improvements in an untreated chronic pain population, beyond regression to the mean and the placebo effect
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The Efficiency of Respiratory Exercises in Rehabilitation of Low Back Pain: A Systematic Review and Meta-Analysis
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12 weeks high intensity interval training versus moderate intensity continuous training in chronic low back pain subjects: a randomised single-blinded feasibility study
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The comparison of Pilates with cognitive functional therapy in adults with chronic neck pain: a protocol for randomized controlled trial
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Designing multimedia patient education materials for adolescent idiopathic scoliosis: A protocol for a feasibility randomized controlled trial of patient education videos
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The effect of pelvic clock exercises on pain reduction and lumbopelvic proprioception in middle-aged women with chronic nonspecific low back pain (CNSLBP)
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Effects of pain neuroscience education combined with neuromuscular exercises on pain, functional disability and psychological factors in chronic low back pain: A study protocol for a single-blind randomized controlled trial
Alvani, E., Sheikhi, B., Letafatkar, A., & Rossettini, G. (2024) · PLoS ONE · doi:10.1371/journal.pone.0309679 · Cited by 3 · see citing works
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Cognitive functional therapy compared with core exercise and manual therapy in patients with chronic low back pain: randomised controlled trial
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Individualised cognitive functional therapy compared with a combined exercise and pain education class for patients with non-specific chronic low back pain: study protocol for a multicentre randomised controlled trial
O’Keeffe, M., Purtill, H., Kennedy, N., O’Sullivan, P., Dankaerts, W., Tighe, A., Allworthy, L., Dolan, L., Bargary, N., & O’Sullivan, K. (2015) · BMJ Open · doi:10.1136/bmjopen-2014-007156 · Cited by 53 · see citing works
Self-citation
Individualised cognitive functional therapy compared with a combined exercise and pain education class for patients with non-specific chronic low back pain: A multicentre randomised controlled trial
O’Keeffe, M., Purtill, H., Kennedy, N., O’Sullivan, P., Dankaerts, W., Tighe, A., Allworthy, L., Dolan, L., Bargary, N., & O’Sullivan, K. (2016) · Manual Therapy · doi:10.1016/j.math.2016.05.130 · Cited by 1 · see citing works
Self-citation
COGNITIVE FUNCTIONAL THERAPY COMPARED WITH EXERCISE AND EDUCATION CLASSES FOR NON-SPECIFIC CHRONIC LOW BACK PAIN: A MULTICENTRE RANDOMISED CONTROLLED TRIAL
O'Keeffe, M., O’Sullivan, P., Purtill, H., Bargary, N., & O'Sullivan, K. (2026) · World Physiotherapy Congress Archive · doi:10.82161/bg95-jf10
Self-citation
Cognitive functional therapy in patients with non‐specific chronic low back pain—a randomized controlled trial 3‐year follow‐up
Fersum, K. V., Smith, A. J., Kvåle, A., Skouen, J. S., & O’Sullivan, P. (2019) · European Journal of Pain · doi:10.1002/ejp.1399 · Cited by 122 · see citing works
Self-citation

Authors: O'Keeffe, M., O'Sullivan, P., Purtill, H., Bargary, N., & O'Sullivan, K.
Affiliations: Institute for Musculoskeletal Health, Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
School of Physiotherapy and Exercise Science, Curtin University, Shenton Park, Perth, Western Australia, Australia
University of Limerick (IE)
Health Research Institute, University of Limerick, Limerick, Ireland
ORCID: O'Keeffe, Mary
Purtill, Helen
Bargary, Norma
O'Sullivan, Kieran
Venue: British Journal of Sports Medicine
Publisher: BMJ
Published: 2019-10-19
Volume: 54
Issue: 13
Pages: 782-789
ISSN: 0306-3674 (ISSN-L)
1473-0480
DOI: 10.1136/bjsports-2019-100780
PMC: PMC7361017
OpenAlex: W2981005913
Cited by: 217
References: 54
Citations by year: 2026: 21 · 2025: 27 · 2024: 55 · 2023: 45 · 2022: 27 · 2021: 27 · 2020: 14 · 2019: 1
FWCI: 10.69
Type: journal article
Language: en
Open access: hybrid
doi.org
Licence: cc-by-nc
creativecommons.org/licenses/by-nc/4.0/ (unspecified)
Locations: British Journal of Sports Medicine (publishedVersion, cc-by-nc)
PubMed Central (publishedVersion, cc-by-nc)
PubMed (publishedVersion)
Cork Open Research Archive (University College Cork, Ireland) (publishedVersion, other-oa)
University of Limerick Institutional Repository (University of Limerick) (acceptedVersion, cc-by-nc-sa)
University of Limerick Institutional Repository (University of Limerick) (acceptedVersion, other-oa)
Zenodo (CERN European Organization for Nuclear Research) (submittedVersion, cc-by)
Arrow@dit (Dublin Institute of Technology) (submittedVersion, cc-by-nc-sa)
Arrow@dit (Dublin Institute of Technology) (submittedVersion, cc-by-nc)
Figshare (submittedVersion, cc-by-nc-sa)
HighWire Press Open Archive (submittedVersion)
Lenus, The Irish Health Repository (Dr Steevens Hospital Library) (submittedVersion, cc-by-nc)
University of Limerick Institutional Repository (University of Limerick)
Funders: University of Limerick
Irish Research Council
Topics: Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Treatment
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Pregnancy-related medical research
Keywords: cognitive functional therapy, chronic low back pain, disability, pain intensity, musculoskeletal pain
MeSH terms: Adult, Aged, Combined Modality Therapy, Exercise Therapy, Female, Humans, Male, Middle Aged, Patient Education as Topic, Cognitive Behavioral Therapy, Low Back Pain, Intention to Treat Analysis, Chronic Pain

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

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