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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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    Still in doubt about the efficacy of Cognitive Functional Therapy for chronic nonspecific low back pain. Letter to the editor concerning the trial by O’Keeffe et al. 2019.
    • Ney Meziat-FIlho, Assistant Professor / Physiotherapist Postgraduate Program in Rehabilitation Sciences, Centro Universitário Augusto Motta, UNISUAM, Rio de Janeiro, Brazil
    • Other Contributors:
      • Arthur de Sá Ferreira, Associate Professor / Physiotherapist
      • Jessica Fernandez, PhD student / Physiotherapist
      • Julia Castro, PhD student / Physiotherapist
      • Fabiana Terra Cunha Belache, PhD / Physiotherapist
      • Luis Claudio Lemos Correia, Professor / Physician

    We congratulate O’Keeffe et al. [1] for their research on the comparative efficacy of Cognitive Functional Therapy (CFT) and physiotherapist-delivered group-based exercise and education for individuals with chronic low back pain (CLBP). Their study shows that “CFT can reduce disability, but not pain, at 6 months compared with the group-based exercise and education intervention”. The CFT approach is very promising and has caught the attention and interest of a number of clinicians worldwide in the management of non‐specific disabling CLBP. The study by O’Keeffe et al. [1] has methodological strengths compared to a previous clinical trial by Vibe Fersum et al. [2,3] such as a higher sample size which means it is less vulnerable to type-II error. Nonetheless, some shortcomings threaten substantially the risk of bias and type I error that are worthy of further discussion.

    The first is the choice of three physiotherapists for delivering both interventions in this trial. This aspect was considered by O’Keeffe et al. [1] as a strength of the study because it arguably minimized differences in clinicians’ expertise and communication style. Notwithstanding, this fact could also have decreased the treatment effect on the control group. It is important to remember that the trial was performed by the research group that not only developed CFT but also has trained the physiotherapists on such an approach, and thus the enthusiasm and motivation to apply the intervention on the CFT...

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    Conflict of Interest:
    None declared.