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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dc.contributor.author O'Keeffe, Mary
dc.contributor.author O'Sullivan, Peter
dc.contributor.author Purtill, Helen
dc.contributor.author Bargery, Norma
dc.contributor.author O'Sullivan, Kieran
dc.date.accessioned 2021-02-22T16:13:13Z
dc.date.available 2021-02-22T16:13:13Z
dc.date.issued 2019-10-19
dc.identifier.citation O'Keeffe, M., O'Sullivan, P., Purtill, H., Bargary, N. and O'Sullivan, K. (2020) 'Cognitive functional therapy compared with a group-based exercise and education intervention for chronic low back pain: a multicentre randomised controlled trial (RCT)', British Journal of Sports Medicine, 54(13), pp. 782-789. doi: 10.1136/bjsports-2019-100780 en
dc.identifier.volume 54 en
dc.identifier.issued 13 en
dc.identifier.startpage 782 en
dc.identifier.endpage 789 en
dc.identifier.issn 0306-3674
dc.identifier.uri http://hdl.handle.net/10468/11090
dc.identifier.doi 10.1136/bjsports-2019-100780 en
dc.description.abstract 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). en
dc.description.sponsorship University of Limerick (Open access funding provided by the Health Research Institute, University of Limerick) en
dc.format.mimetype application/pdf en
dc.language.iso en en
dc.publisher BMJ Publishing Group en
dc.rights © Author(s) (or their employer(s)) 2020.This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ en
dc.rights.uri http://creativecommons.org/licenses/by-nc/4.0/ en
dc.subject Low back pain (LBP) en
dc.subject Chronic low back pain (CLBP) en
dc.subject Cognitive functional therapy (CFT) en
dc.title Cognitive functional therapy compared with a group-based exercise and education intervention for chronic low back pain: a multicentre randomised controlled trial (RCT) en
dc.type Article (peer-reviewed) en
dc.internal.authorcontactother Norma Bargery, Insight Centre for Data Analytics, University College Cork, Cork, Ireland. +353-21-490-3000 en
dc.internal.availability Full text available en
dc.description.version Published Version en
dc.contributor.funder University of Limerick en
dc.description.status Peer reviewed en
dc.identifier.journaltitle British Journal of Sports Medicine en
dc.identifier.eissn 1473-0480


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© Author(s) (or their employer(s)) 2020.This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ Except where otherwise noted, this item's license is described as © Author(s) (or their employer(s)) 2020.This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
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