#VisualAbstract: Cognitive functional therapy, with or without movement sensor biofeedback, improves chronic low back pain

1. Patients assigned to cognitive functional therapy (CFT) reported improved quality-adjusted life-years versus usual care.

2. Both CFT groups were found to have significantly reduced societal costs compared to the usual care group.

Evidence Rating Level: 1 (Excellent)

Study Rundown: Chronic low back pain is the leading cause of disability worldwide. Cognitive functional therapy (CFT) is a patient-centered approach that may help to mitigate pain; however, its efficacy in large-scale populations remains unclear. In addition, sensor biofeedback in the setting of chronic back pain is a novel development that may supplement CFT. This randomized controlled trial aimed to compare the safety and efficacy of CFT, with or without sensor biofeedback, for treatment in patients with chronic low back pain. The primary outcome was quality-adjusted life-years (QALYs) while key secondary outcome included cost efficiency. According to study results, patients in the CFT group reported increased QALYs compared to usual care, irrespective of sensor biofeedback use. This study was well-done and included patients assigned to both the sensor and non-sensor groups, thus increasing the validity of results.

Click to read the study in The Lancet

In-depth [randomized-controlled trial]: Between Oct 23, 2018, and Aug 3, 2020, 1011 patients were screened for eligibility across 20 physiotherapy clinics in Australia. Included were patients ≥ 18 years with moderate, functionally limiting back pain for ≥ 3 months. Patients in the usual care group were eligible for treatment options they may be offered in the community, including but not limited to physiotherapy, massage therapy, surgery, medicine, and injections. Patients allocated to the CFT group underwent an individualized plan after meeting with a physiotherapist. The CFT intervention consisted of three main components which includes a reflection component, an exposure and control component, and lifestyle modifications. Altogether, 492 patients (165 to usual care, 164 to CFT only, and 163 to CFT with movement sensor biofeedback) were included in the final analysis. The primary outcome of QALYs was greater in the intervention groups compared to usual care (CFT only mean difference -4.6, 95% confidence interval [CI] -5.9 to -3.4, and CFT plus biofeedback mean difference -4.6, 95% CI -5.8 to -3.3) at week 13. Both interventions were found to be more cost-effective compared to usual care (direct productivity loss -AU$5276). Findings from this study suggest that CFT results in significant improvement in chronic low back pain.

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