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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)
  1. Mary O'Keeffe1,
  2. Peter O'Sullivan2,3,
  3. Helen Purtill4,5,6,
  4. Norma Bargary4,5,
  5. Kieran O'Sullivan5,6,7,8
  1. 1 Institute for Musculoskeletal Health, Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
  2. 2 School of Physiotherapy and Exercise Science, Curtin University, Shenton Park, Perth, Western Australia, Australia
  3. 3 Bodylogic Physiotherapy, Perth, Western Australia, Australia
  4. 4 Department of Mathematics & Statistics, Faculty of Science & Engineering, University of Limerick, Limerick, Ireland
  5. 5 Health Research Institute, University of Limerick, Limerick, Ireland
  6. 6 Aging Research Centre, University of Limerick, Limerick, Ireland
  7. 7 Sports Spine Centre, Aspetar Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
  8. 8 School of Allied Health, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
  1. Correspondence to Dr Mary O'Keeffe, Institute for Musculoskeletal Health, Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia; mary.okeeffe{at}


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 registry (NCT02145728).

  • lower back
  • randomised controlled trial
  • effectiveness
  • physiotherapy

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  • Contributors MO was the PhD student leading the project; responsible for data collection, project management and was responsible for writing the initial version of the manuscript. PO designed the individualised multidimensional intervention (CFT), contributed to clinician training for the trial, participated in the design of the trial and interpretation of the results. HP and NB are statisticians and were responsible for the statistical analysis of the trial. KO was the principal investigator; involved in designing the individualised multidimensional intervention (CFT), contributed to clinician training for the trial, participated in the design and conduct of the trial and interpretation of the results. All authors have revised the manuscript critically for important intellectual content and approved the final version. In doing so, we agree to be accountable for all aspects of the work.

  • Funding This trial did not receive any specific funding but was provided as part of the health service. The PhD student coordinating the trial (MO) received a personal scholarship from the Irish Research Council.

  • Competing interests MO received payments in 2016 for providing a professional development workshop and lecture for clinicians in the individualised multidimensional intervention (CFT) examined in this trial. KO and PO receive payments for CFT workshops and lectures. MO, PO and KO have written editorials and viewpoints which encourage the use of CFT, or its principles, in clinical practice.

  • Patient consent for publication Not required.

  • Ethics approval Ethics approval was obtained from Mayo General Hospital research ethics committee (MGH-14-UL).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon request.

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