Cognitive Functional Therapy provides Long-Term Relief From Low Back Pain

Low back pain is a common problem that affects people worldwide, reducing the quality of life. Although many treatments exist, their effects are often short-term and limited. Cognitive functional therapy (CFT) is a personalized approach that targets the thoughts, emotions, and behaviors related to pain and disability. Adding movement sensor biofeedback to CFT may enhance its effectiveness.

Clinical Trial

A clinical trial compared the outcomes and cost-effectiveness of CFT, with or without biofeedback, to usual care for individuals with chronic, disabling low back pain. The RESTORE trial was conducted in 20 primary care physiotherapy clinics in Australia. Adults over 18 years old, experiencing low back pain for more than three months with moderate limitations in physical activity, were recruited. Participants with severe spinal conditions, medical conditions preventing physical activity, recent pregnancy or childbirth, inadequate English skills, allergies to tape adhesives, scheduled surgery within three months, or unwillingness to travel to trial sites were excluded.

Participants were randomly assigned to receive usual care, CFT only, or CFT plus biofeedback. The primary clinical outcome measured was activity limitation after 13 weeks using the Roland Morris Disability Questionnaire. The primary economic outcome assessed was quality-adjusted life-years (QALYs). Both interventions involved up to seven treatment sessions over 12 weeks, with a booster session at 26 weeks.

Findings

CFT only and CFT plus biofeedback were both more effective than usual care in reducing activity limitations at 13 weeks. The improvements were sustained at 52 weeks. Additionally, both interventions resulted in higher QALYs compared to standard care. From an economic perspective, the societal costs associated with CFT were significantly lower than those of usual care, indicating a more cost-effective approach.

Conclusion

CFT, either with or without biofeedback, can lead to substantial and long-lasting improvements in chronic disabling low back pain. Moreover, these interventions are more cost-effective than usual care. This research highlights the potential benefits of personalized approaches to managing low back pain and supports the integration of movement sensor biofeedback into treatment strategies. By targeting pain-related thoughts, emotions, and behaviors, CFT offers a promising avenue for enhancing patient outcomes and reducing the burden of low back pain on individuals.
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