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Phys Ther. 2018 May 1;98(5):408-423. doi: 10.1093/ptj/pzy022.

Cognitive Functional Therapy: An Integrated Behavioral Approach for the Targeted Management of Disabling Low Back Pain.

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School of Physiotherapy, Curtin University, Shenton Park, Western Australia, and Bodylogic Physiotherapy, Private Practice, Perth, Australia.
School of Physiotherapy, Curtin University, and Bodylogic Physiotherapy.
Sydney School of Public Health, University of Sydney, Australia, and Department of Allied Health, University of Limerick, Limerick, Ireland.
School of Physiotherapy, Curtin University.
Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation sciences, Katholieke Universiteit Leuven, Leuven, Belgium.
Department of Global Public Health and Primary Care, Universitetet i Bergen Institutt for indremedisin, Bergen, Norway.
Sports Spine Centre, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar and Department of Allied Health, University of Limerick.


Biomedical approaches for diagnosing and managing disabling low back pain (LBP) have failed to arrest the exponential increase in health care costs, with a concurrent increase in disability and chronicity. Health messages regarding the vulnerability of the spine and a failure to target the interplay among multiple factors that contribute to pain and disability may partly explain this situation. Although many approaches and subgrouping systems for disabling LBP have been proposed in an attempt to deal with this complexity, they have been criticized for being unidimensional and reductionist and for not improving outcomes. Cognitive functional therapy was developed as a flexible integrated behavioral approach for individualizing the management of disabling LBP. This approach has evolved from an integration of foundational behavioral psychology and neuroscience within physical therapist practice. It is underpinned by a multidimensional clinical reasoning framework in order to identify the modifiable and nonmodifiable factors associated with an individual's disabling LBP. This article illustrates the application of cognitive functional therapy to provide care that can be adapted to an individual with disabling LBP.

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