Cognitive Functional Therapy Compared with a Group-based Exercise and Education Intervention for Chronic Low Back Pain: A Multicentre Randomised Controlled Trial.

Review written by Steve Kamper info

Key Points

  1. Cognitive Functional Therapy (CFT) had no clinically meaningful effect on pain or disability compared to group education and exercise classes.
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Research evidence reporting the effectiveness of interventions for low back pain is underwhelming. While recommendations in international guidelines are quite consistent (1), clinical trials show that available treatments typically result in small effects compared to no or minimal care. This leads to numerous groups and individuals making claims about superiority of various treatments based on anecdote and clinical observation. A consequence is the problem of inconsistent and low-value care seen around the world (2,3).

Researchers and clinicians have proposed that important clinical differences within the population of people with low back pain are responsible for ineffectiveness of generic models of care. This has led to the development of various individualized approaches including Cognitive Functional Therapy (CFT) (4). CFT is a treatment framework that aims to identify and address individual physical, lifestyle and psychological barriers to recovery and help patients self-manage their condition.

This study was a randomised comparison of the effectiveness of CFT versus group education and exercise classes in people with chronic low back pain. Key outcomes were pain and disability.

Available treatments for low back pain typically result in only small effects compared to no or minimal care.
Individualized care is probably not more effective than group treatments for people with chronic back pain.


Adults with low back pain of greater than 6 months duration who presented to two primary care centres or were referred to one public hospital in Ireland were eligible. Consenting participants were randomly allocated to either CFT or group treatment.

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