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

Tytuł:: Cognitive functional therapy compared with a group-based exercise and education intervention for chronic low back pain: a multicentre randomised controlled trial (RCT).
Autorzy:: O'Keeffe M; Institute for Musculoskeletal Health, Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia .
O'Sullivan P; School of Physiotherapy and Exercise Science, Curtin University, Shenton Park, Perth, Western Australia, Australia.; Bodylogic Physiotherapy, Perth, Western Australia, Australia.
Purtill H; Department of Mathematics & Statistics, Faculty of Science & Engineering, University of Limerick, Limerick, Ireland.; Health Research Institute, University of Limerick, Limerick, Ireland.; Aging Research Centre, University of Limerick, Limerick, Ireland.
Bargary N; Department of Mathematics & Statistics, Faculty of Science & Engineering, University of Limerick, Limerick, Ireland.; Health Research Institute, University of Limerick, Limerick, Ireland.
O'Sullivan K; Health Research Institute, University of Limerick, Limerick, Ireland.; Aging Research Centre, University of Limerick, Limerick, Ireland.; Sports Spine Centre, Aspetar Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.; School of Allied Health, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland.
Źródło:: British journal of sports medicine [Br J Sports Med] 2020 Jul; Vol. 54 (13), pp. 782-789. Date of Electronic Publication: 2019 Oct 19.
Typ publikacji:: Journal Article; Multicenter Study; Randomized Controlled Trial
Język:: English
Imprint Name(s):: Publication: London : BMJ Publishing Group
Original Publication: Loughborough, Eng.
MeSH Terms:: Cognitive Behavioral Therapy*/methods
Exercise Therapy*/methods
Patient Education as Topic*/methods
Chronic Pain/*therapy
Low Back Pain/*therapy
Adult ; Aged ; Chronic Pain/psychology ; Combined Modality Therapy ; Female ; Humans ; Intention to Treat Analysis ; Low Back Pain/psychology ; Male ; Middle Aged
References:: Spine J. 2014 May 1;14(5):816-36.e4. (PMID: 24412032)
Phys Ther. 2018 May 1;98(5):408-423. (PMID: 29669082)
Br J Sports Med. 2017 Jan;51(2):126-132. (PMID: 27343238)
Lancet. 2011 Oct 29;378(9802):1560-71. (PMID: 21963002)
Ann Intern Med. 2017 Apr 4;166(7):514-530. (PMID: 28192789)
J Rehabil Med. 2017 Jul 7;49(7):591-597. (PMID: 28657642)
Lancet. 2018 Jun 9;391(10137):2356-2367. (PMID: 29573870)
Br J Sports Med. 2017 Mar;51(6):489-490. (PMID: 27697936)
Clin J Pain. 2014 Sep;30(9):755-65. (PMID: 24451630)
BMJ Open. 2015 Jun 01;5(6):e007156. (PMID: 26033941)
Lancet. 2018 Jun 9;391(10137):2384-2388. (PMID: 29573871)
BMC Musculoskelet Disord. 2014 Jul 10;15:229. (PMID: 25012528)
Br J Sports Med. 2018 May;52(9):553-555. (PMID: 28756393)
Cochrane Database Syst Rev. 2010 Jul 07;(7):CD002014. (PMID: 20614428)
Lancet. 2017 Feb 18;389(10070):736-747. (PMID: 27745712)
Pain. 1999 Nov;83(2):157-62. (PMID: 10534586)
J Pain. 2016 Jul;17(7):755-74. (PMID: 26844416)
BMC Musculoskelet Disord. 2018 Apr 12;19(1):113. (PMID: 29650015)
Spine (Phila Pa 1976). 2006 Mar 15;31(6):698-704. (PMID: 16540876)
Spine (Phila Pa 1976). 2000 Aug 15;25(16):2114-25. (PMID: 10954644)
Best Pract Res Clin Rheumatol. 2016 Dec;30(6):1074-1083. (PMID: 29103550)
Chiropr Man Therap. 2015 Sep 11;23:26. (PMID: 26366285)
Lancet. 2010 Mar 13;375(9718):916-23. (PMID: 20189241)
Cochrane Database Syst Rev. 2005 Jul 20;(3):CD000335. (PMID: 16034851)
BMC Womens Health. 2012 Mar 29;12:7. (PMID: 22458415)
Gen Hosp Psychiatry. 2016 Nov - Dec;43:63-70. (PMID: 27796261)
Int J Nurs Stud. 2015 Feb;52(2):635-48. (PMID: 25480459)
Stat Med. 2016 Mar 30;35(7):966-77. (PMID: 26415869)
Spine (Phila Pa 1976). 2000 Nov 15;25(22):2940-52; discussion 2952. (PMID: 11074683)
Eur Spine J. 2018 Jan;27(1):60-75. (PMID: 28429142)
Cochrane Database Syst Rev. 2013 Aug 19;(8):CD003010. (PMID: 23959683)
BMJ. 2016 Jan 15;352:i189. (PMID: 26773001)
Eur J Pain. 2012 Jan;16(1):3-17. (PMID: 21719329)
Eur J Pain. 2013 Jul;17(6):916-28. (PMID: 23208945)
J Orthop Sports Phys Ther. 2016 Nov;46(11):932-937. (PMID: 27802794)
AJNR Am J Neuroradiol. 2015 Dec;36(12):2394-9. (PMID: 26359154)
Epidemiology. 2000 Sep;11(5):550-60. (PMID: 10955408)
Eur J Pain. 2019 Sep;23(8):1416-1424. (PMID: 30974479)
Clin J Pain. 2004 Mar-Apr;20(2):61-9. (PMID: 14770044)
Scand J Public Health. 1999 Mar;27(1):63-72. (PMID: 10847674)
Lancet. 2018 Jun 9;391(10137):2368-2383. (PMID: 29573872)
Pain. 1993 Feb;52(2):157-68. (PMID: 8455963)
Spine J. 2016 Jan 1;16(1):105-16. (PMID: 26523965)
Spine (Phila Pa 1976). 2011 Oct 15;36(22):1891-5. (PMID: 21192286)
Phys Ther. 2014 Jan;94(1):91-100. (PMID: 24009343)
J Orthop Sports Phys Ther. 2019 Jun;49(6):453-463. (PMID: 30759355)
Contributed Indexing:: Keywords: effectiveness; lower back; physiotherapy; randomised controlled trial
Molecular Sequence:: ClinicalTrials.gov NCT02145728
Entry Date(s):: Date Created: 20191021 Date Completed: 20200623 Latest Revision: 20210520
Update Code:: 20240105
PubMed Central ID:: PMC7361017
DOI:: 10.1136/bjsports-2019-100780
PMID:: 31630089
: Czasopismo naukowe

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).
Competing Interests: 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.
(© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Comment in: J Physiother. 2021 Apr;67(2):141. (PMID: 33744183)

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