The effectiveness of cognitive functional therapy for patients with chronic non-specific low back pain.

Purpose

This aim of this review was to evaluate the effectiveness of cognitive functional therapy (CFT) in patients with chronic non-specific low back pain (CNSLBP).

Approach

A systematic search of the following online databases was conducted including Medline, EMBASE, CINAHL, Cochrane and PEDro (inception to end July 2018). Only randomised controlled trials (RCTs) and observational studies (e.g. cohort studies and case-control studies) that evaluate the effectiveness of CFT on CNSLBP were included. Primary outcomes were pain severity and functional disability. Secondary outcomes were anxiety and depression, and fear-avoidance beliefs of physical activity. PRISMA guidelines was followed to conduct this review. PEDro scale and Modified Downs and Black assessment checklist were used to assess the quality of studies. Two authors independently extracted data and assessed the quality of included studies.

Outcomes

One RCT and one multiple case-cohort study met the eligibility criteria. The RCT study scored 5/10 (low quality) on the PEDro scale, and the multiple case-cohort study scored 20/28 (good quality) on the Modified Downs and Black assessment checklist. Overall, both trials reported significant improvement for pain and disability in the short-term and long-term. Moreover, depression and anxiety, and fear-avoidance beliefs of physical activity were significantly improved.  

The current evidence suggests that CFT shows early promise as an effective intervention to improve pain and disability, as well as improve depression and anxiety, and fear avoidance beliefs of physical activity. However, the results must be taken with caution as the evidence comes from a limited amount of high-quality evidence in this topic.

Implications

To the best of our knowledge, this is the first systematic review that evaluates the literature for the effectiveness of the CFT in managing patients with CNSLBP. Currently, very few published studies have evaluated the efficacy of CFT. However, the suggestion from early trials by the originators of the method, is that CFT shows early promise as an effective intervention.

Fund acknowledgements

None. 

Additional notes

This work was presented at Physiotherapy UK 2019