Efficacy of Classification Based 'Cognitive Functional Therapy' in Patients With Non Specific Chronic Low Back Pain

University of Bergen121 enrolled

Overview

A randomized controlled trial of the efficacy of classification based cognitive functional physiotherapy according to the system proposed by Peter O'Sullivan as compared to manual therapy and exercise in patients with non specific chronic low back pain. The investigators hypothesis was that treatment targeted at the mechanism behind the problem from a multidimensional perspective would be superior to traditional treatment.

NSCLBP is widely viewed as a multifactorial biopsychosocial pain syndrome. It has been proposed by several authors that NSCLBP represents a vicious cycle associated with different combinations of maladaptive; cognitive (negative beliefs, fear avoidance behaviours, catastrophising, depression, stress, lack of pacing and coping), physical (pain provocative postures, movement patterns and pain behaviours) and lifestyle (inactivity, rest) behaviours that act to promote pain and disability. However a recent systematic review suggests that this change in paradigm and our new understanding of NSCLBP has not resulted in clinical trials utilizing multidimensional classification systems or targeted interventions based on the underlying mechanisms. line with this shift in paradigm a novel multidimensional classification system has been developed incorporating the biopsychosocial model, which subgroups patients based on their presentation of. with matched interventions directed at the maladaptive cognitive, physical and lifestyle behaviours associated with the disorder.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

SINGLE

Enrollment

121

Conditions

Chronic Low Back Pain

Interventions

Cognitive Functional TherapyOTHER

A novel multidimensional classification system has been developed incorporating the biopsychosocial model, which subgroups patients based on their presentation with matched interventions directed at the maladaptive cognitive, physical and lifestyle behaviours associated with the disorder. The intervention is called 'cognitive functional therapy' as it directly challenges these behaviours in a functionally specific and graduated manner.

Manual therapy and exerciseOTHER

Patients in this group was treated with joint mobilization or manipulation techniques applied to the spine or pelvis primarily and was designed to be consistent with best current manual therapy practice in Norway. The particular dose and techniques were at the discretion of the treating therapist, based on each participant's objective and physical examination findings. In addition most of the patients in this group was given exercises or a home exercise program.

Eligibility

Sex: ALLMin age: 18 YearsMax age: 65 YearsHealthy volunteers:

Medical Language ↔ Plain English

Inclusion Criteria: * all patients with non-specific LBP for more that 8 weeks duration * mechanical provocation of pain with postures, movement and activities * localised pain in the area from T12 to gluteal folds * moderate ongoing LBP with a VAS \> 2/10 * disability had to be higher than 14% on Oswestry Disability Index Exclusion Criteria: * sick listed for more than 4 months continuous duration * acute exacerbation of LBP * radicular pain with positive neural tissue provocation test * any low limb surgery on the last 3 months * surgery involving the lumbar spine (fusion) * pregnancy * psychiatric disorders - somatisation * dominant psycho-social problems * widespread non-specific pain disorder (no primary LBP focus) * specific diagnoses: active rheumatologic disease, progressive neurological disease, serious cardiac or other internal medical condition, malignant basic diseases, acute traumas, infections, or acute vascular catastrophies

Locations (1)

University of Bergen

Bergen, Hordaland, Norway

Outcomes

Primary Outcomes

Pain

Pain was assessed using a pain numerical rating scale from 0 to 10

Time frame: 12 months

Disability

Disability measured by Oswestry Disability Index.

Time frame: 12 months

Secondary Outcomes

Well being

Hopkins Symptoms Checklist.

Time frame: 12 months

Beliefs

Fear Avoidance Beliefs Questionnaire

Time frame: 12 months

Screening questionnaire

The Ørebro Pain Screening Questionnaire

Time frame: 12 months

Patient satisfaction

patient satisfaction. 5 items scale

Time frame: 12 months

Data from ClinicalTrials.gov

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