A three-year follow-up of a randomized trial found that cognitive functional therapy, with or without movement sensor biofeedback, led to sustained improvements in disability and pain intensity in adults with chronic low back pain.
The study enrolled 492 participants from 20 physiotherapy clinics in Australia. Patients were randomly assigned to one of three groups: usual care, cognitive functional therapy (CFT) alone, or CFT with biofeedback. CFT is a personalized approach that addresses both physical and psychological factors contributing to chronic pain. It includes pain education, graded exposure to feared movements, and lifestyle coaching focused on physical activity, sleep, and stress. At the three-year mark, both CFT groups showed significantly greater improvements compared with usual care.
Disability was measured using the Roland Morris Disability Questionnaire (RMDQ; 0–24 scale). Participants in the CFT group improved by 3.5 points (95% CI, –4.9 to –2.0), while those in the CFT plus biofeedback group improved by 4.1 points (95% CI, –5.6 to –2.6) compared with the usual care group.
Pain intensity, measured by the mean of three numeric rating scales, also improved in both intervention groups. The CFT-only group reported a reduction of 1.0 points (95% CI, –1.6 to –0.5), and the CFT plus biofeedback group improved by 1.5 points (95% CI, –2.1 to –0.9) versus usual care.
There was no significant difference between the two CFT groups, indicating that biofeedback did not enhance outcomes.
More than 60% of participants in both CFT groups experienced a clinically meaningful improvement in disability, defined as a reduction of at least 5 points on the RMDQ, compared with 33% in the usual care group. Additionally, nearly half of participants in the CFT groups maintained disability scores below 4 from year one to year three, a level associated with recovery.
Participants had chronic low back pain lasting more than three months and reported moderate to high levels of physical limitation. The average pain duration before joining the study was five years. CFT was delivered over seven sessions in 12 weeks, with a booster session at six months.
The findings support CFT as an effective long-term intervention for chronic low back pain. Sensitivity and exploratory analyses confirmed the durability of the results. The use of movement sensor biofeedback did not improve outcomes, suggesting CFT alone is sufficient.
This trial is one of the largest and longest studies to demonstrate sustained benefits of a conservative intervention for chronic low back pain. Its large sample size, high retention rate at three years, and robust methodology contribute to the reliability of its findings.
Full disclosures can be found in the published study.
Source: The Lancet Rheumatology