Cognitive Functional Therapy (CFT) Compared With Core Training Exercise and Manual Therapy (CORE-MT) in Patients With Chronic Low Back Pain
Condition: Low Back Pain; Back Pain; Pain; Signs and Symptoms; Neuromuscular Manifestations
MeSH terms: Neuromuscular Manifestations; Back Pain; Low Back Pain
Study type: Interventional

Summary: 
      There is evidence, of a single randomized controlled trial, that CFT is better than combined
      manual therapy and motor control exercise for chronic low back pain. However, this study had
      significant methodological shortcomings regarding the failure to carry out the intention to
      treat analysis and a considerable loss of follow-up of patients. As it is, it is important to
      carry out more studies involving CFT compared to other interventions already used in clinical
      practice and to correct these methodological shortcomings. Therefore, the aim of the study is
      to assess the efficacy of Cognitive Functional Therapy in patients with chronic non specific
      low back pain.
    

Detailed description: 
      Randomized controlled trial with concealed allocation, blinded assessor, blinded participants
      and intention to treat analysis. Patients will be evaluated at baseline, 8 weeks, 6 and 12
      months after randomization, to assess the maintenance of any effect of treatment. The
      patients in the CFT group will be treated by a physical therapists that attended twice the
      CFT workshops with two of the tutors of the method. She completed 106 hours of training
      including workshops, patient examinations and a pilot study with the supervision of a
      physical therapist with more than three years of clinical experience in CFT. Patients in
      CORE-MT group will be treated by a physical therapist with clinical experience in manual
      therapy and core training exercises.
    

Intervention name(s): Cognitive Functional Therapy; Core Training Exercise and Manual Therapy
Intervention type(s): Behavioral; Other
Intervention description(s): There will be four main components in the intervention, following the protocol used by O'Keefe et al. (2015):
The cognitive component will focus on on the multidimensional nature of persistent pain about individual beliefs, and how emotions and behaviors (movement and lifestyle) can reinforce a vicious cycle of pain and disability.
Specific Functional training is designed to normalize maladaptive or provocative movement and posture.
Functional integration directed to activities of daily life that are avoided by the patient (rolling in bed, sitting, sitting to standing, walking, bending and lifting)
Patients will be advised to gradually increase physical activity based on their preference, also focusing on sleep hygiene, stress, and management strategies; According to the pragmatic clinical decision of the physiotherapist responsible for this intervention arm, participants allocated to the comparison group will be treated with active exercises will involve contractions of abdominal and back muscles in different functional positions, as well as joint mobilization or manipulation techniques applied to the lower back or pélvis, when necessary. Most patients in this group will receive exercises to perform at home, but not related to CFT.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Randomized controlled trial with concealed allocation, blinded assessor, blinded participants and intention to treat analysis. Patients will be evaluated at baseline, 8 weeks, 6 and 12 months after randomization, to assess the maintenance of any effect of treatment. The patients in the CFT group will be treated by a physical therapists that attended twice the CFT workshops with two of the tutors of the method. She completed 106 hours of training including workshops, patient examinations and a pilot study with the supervision of a physical therapist with more than three years of clinical experience in CFT. Patients in CORE group will be treated by a physical therapist with clinical experience in manual therapy and core training exercises.
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Treatment
Keywords: back pain; physiotherapy; exercise therapy; cognitive functional therapy; low back pain; backache; lower back pain; lumbago; multidimensional; biopsychosocial