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Eur J Pain. 2019 Apr 11. doi: 10.1002/ejp.1399. [Epub ahead of print]

Cognitive Functional Therapy in patients with Non Specific Chronic Low Back Pain A randomized controlled trial 3-year follow up.

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Physiotherapy Research Group, Department of Public Health and Primary Health Care, University of Bergen, Norway.
School of Physiotherapy, Curtin University, Bentley, 6102, WA, Australia.
Research group Movement and Function, Western Norway University of Applied Science, Bergen, Norway.
The Outpatient Spine Clinic, Department of Physical Medicine and Rehabilitation, Haukeland University Hospital, Bergen, Norway.



This randomized controlled trial investigated the efficacy of cognitive functional therapy (CFT) compared with manual therapy and exercise (MT-EX) for people with non-specific chronic low back pain (NSCLBP) at 3-year follow-up.


121 patients were randomized to CFT (n=62) or MT-EX (n=59). 3-year data were available for 30 (48.4%) participants in the CFT group, and 33 (55.9%) participants in the MT-EX group. The primary outcomes were disability (Oswestry disability Index (ODI)) and pain intensity (numerical rating scale (NRS)) and secondary outcomes were anxiety/depression (Hopkins Symptoms Checklist) and pain related fear (Fear Avoidance Belief Questionnaire). A full intention to treat analysis was conducted using linear mixed models.


Significantly greater reductions in disability were observed for the CFT group, with ODI scores at 3-years 6.6 points lower in the CFT than the MT-EX group (95%CI:-10.1 to -3.1, p<.001, standardized effect size =0.70). There was no significant difference in pain intensity between the groups at 3 years (0.6 points 95%CI:-1.4 to 0.3, p=.195). Significantly greater reductions were also observed for the CFT group for Hopkins Symptoms Checklist and Fear Avoidance Belief Questionnaire (Work).


CFT is more effective at reducing disability, depression/anxiety and pain related fear, but not pain, at 3-year follow-up than MT-EX. This article is protected by copyright. All rights reserved.


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