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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)
Open accessAbstract
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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“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].”
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“However, Hayden et al. noted that although CPT consistently improves long-term functional outcomes in CLBP management, the quality of evidence supporting its ef fi cacy in short-term pain relief is relatively low (O ’ Keeffe et al., 2020; Hayden et al., 2021).”
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Multidisciplinary expert consensus on clinical diagnosis and therapies for low back pain
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Advances in physiotherapy for chronic low-back pain: a level I systematic review
Migliorini, F., Maffuli, N., Schäfer, L., Manocchio, N., Bossa, M., & Foti, C. (2026) · Journal of Orthopaedics and Traumatology · doi:10.1186/s10195-026-00972-0
“…exposure and lifestyle changes) was more effective than manual therapy and exercise (MT-EX) in reducing disability at 6-months and 1-year follow-up [156], but also at 3-year follow-up without concomitant reductions in pain intensity, suggesting a decoupling of the pain – disability relationship,…”
Influential
Metadata
- 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
- 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
- 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
- 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 › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Musculoskeletal pain and rehabilitation
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Treatment
- Health Sciences › Medicine › Obstetrics and Gynecology › 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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