• Julia Castro, Luis Correia, Bruno de Sousa Donato, Bruno Arruda, Felipe Agulhari, Marina J Pellegrini, Fabiana T C Belache, Cíntia P de Souza, Jessica Fernandez, Leandro A C Nogueira, ReisFelipe J JFJJInstituto Federal do Rio de Janeiro (IFRJ), Rio de Janeiro, Brazil.Department of Clinical Medicine, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil.Pain in Motion Research Group, Department of Physiotherapy, Human Ph, Arthur de Sá Ferreira, and Ney Meziat-Filho.
• Postgraduate Program in Rehabilitation Science, Centro Universitário Augusto Motta (UNISUAM), Rio de Janeiro, Brazil.
• Pain. 2022 Dec 1; 163 (12): 243024372430-2437.

AbstractCognitive functional therapy (CFT) is a physiotherapy-led intervention that has evolved from an integration of foundational behavioral psychology and neuroscience within the physiotherapist practice directed at the multidimensional nature of chronic low back pain (CLBP). The current evidence about the comparative effectiveness of CFT for CLBP is still scarce. We aimed to investigate whether CFT is more effective than core training exercise and manual therapy (CORE-MT) in pain and disability in patients with CLBP. A total of 148 adults with CLBP were randomly assigned to receive 5 one-hour individualized sessions of either CFT (n = 74) or CORE-MT (n = 74) within a period of 8 weeks. Primary outcomes were pain intensity (numeric pain rating scale, 0-10) and disability (Oswestry Disability Index, 0-100) at 8 weeks. Patients were assessed preintervention, at 8 weeks and 6 and 12 months after the first treatment session. Altogether, 97.3% (n = 72) of patients in each intervention group completed the 8 weeks of the trial. Cognitive functional therapy was more effective than CORE-MT in disability at 8 weeks (MD = -4.75; 95% CI -8.38 to -1.11; P = 0.011, effect size= 0.55) but not in pain intensity (MD = -0.04; 95% CI -0.79 to 0.71; P = 0.916). Treatment with CFT reduced disability, but the difference was not clinically important compared with CORE-MT postintervention (short term) in patients with CLBP. There was no difference in pain intensity between interventions, and the treatment effect was not maintained in the mid-term and long-term follow-ups.Copyright © 2022 International Association for the Study of Pain.

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