Cognitive Functional Therapy for People with Nonspecific Persistent Low Back Pain in a Secondary Care Setting—A Propensity Matched, Case–Control Feasibility Study

Background Effective, inexpensive, and low-risk interventions are needed for patients with nonspecific persistent low back pain (NS-PLBP) who are unresponsive to primary care interventions. Cognitive functional therapy (CFT) is a multidimensional behavioral self-management approach that has demonstrated promising results in primary care and has not been tested in secondary care. Objective To investigate the effect of CFT and compare it with usual care for patients with NS-PLBP. Design Case–control study. Setting A secondary care spine center. Subjects Thirty-nine patients received a CFT intervention and were matched using propensity scoring to 185 control patients receiving usual care. Methods The primary outcome was Roland Morris Disability Questionnaire (0–100 scale) score. Group-level differences at six- and 12-month follow-up were estimated using mixed-effects linear regression. Results At six-month follow-up, a statistically significant and clinically relevant difference in disability favored the CFT group (–20.7, 95% confidence interval [CI] = –27.2 to –14.2, P < 0.001). Significant differences also occurred for LBP and leg pain, fear, anxiety, and catastrophizing in favor of CFT. At 12-month follow-up, the difference in disability was smaller and no longer statistically significant (–8.1, 95% CI = –17.4 to 1.2, P = 0.086). Differences in leg pain intensity and fear remained significantly in favor of CFT. Treatment satisfaction was significantly higher in the CFT group at six- (93% vs 66%) and 12-month (84% vs 52%) follow-up. Conclusions These findings support that CFT is beneficial for patients with NS-PLBP who are unresponsive to primary care interventions. Subsequent randomized controlled trials could incorporate booster sessions, which may result in larger effects at 12-month follow-up.