Cognitive functional therapy vs. movement system impairment-based therapy for low back pain

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Created On: 11/12/2023

A single-blind randomized controlled trial was conducted to determine the efficacy of two different approaches, cognitive functional therapy (CFT) and treatment based on the movement system impairment (MSI) framework, on variables such as gait kinetics, Kinesiophobia, disability and intensity of pain in chronic non-specific low back pain (CNSLBP) management.

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Key take away

In people having chronic non-specific low back pain, cognitive functional therapy is superior to movement system impairment-based treatment in reducing pain and disability.

Background

Method

In total, 91 individuals suffering from CNSLBP were randomized into two groups: one receiving CFT (consisting of 45 participants) and the other undergoing MSI-based treatment (comprising 46 individuals). Both groups underwent an 8-week training program. The researchers gauged the major endpoint, which focused on pain intensity (using the Numeric rating scale [NRS]), along with secondary endpoints like disability (measured through the Oswestry disability index [ODI]), Kinesiophobia (assessed with the Tampa Kinesiophobia Scale), and vertical ground reaction force (VGRF) parameters at self-selected and faster speeds (measured on a Force distributor treadmill).

Participants' assessments took place at three time points: baseline, immediately after the 8-week intervention (post-treatment), and six months following the initial treatment. The researchers employed mixed-model ANOVA to analyze the influence of the interaction between group (CFT vs. MSI-based therapy) and time (baseline vs. post-therapy vs. 6-month follow-up) on each of the measurements.

Result

At the eight-week mark, it was observed that CFT outperformed MSI-based treatment in several aspects. CFT demonstrated substantial superiority in minimizing pain intensity (Effect size [ES] = 2.41), ODI (ES = 2.15), and kinesiophobia (ES = 2.47). Additionally, CFT yielded more notable enhancements in VGRF parameters, both at self-selected (First Peak Force [FPF] [ES = 3], Second Peak Force [SPF] [ES = 0.5], Mid-Support Force [MSF] [ES = 0.67], Weight Acceptance Rate [WAR] [ES = 1.53], Push-Off Rate [POR] [ES = 0.8]) and faster speeds, FPF (ES = 1.33, MSF [ES = 0.57], WAR [ES = 0.67], POR [ES = 2.91]) when compared to MSI, with the exception of SPF (ES = 0.0) at the eight-week evaluation point.

Conclusion

CFT appeared to deliver more favorable outcomes in both clinical and cognitive aspects compared to the MSI-based treatment for CNSLBP. Notably, the positive effects of these treatments were sustained even at the six-month follow-up. Additionally, CFT showed superior improvements in gait kinetics. These findings suggest that CFT could be a suitable treatment option in clinical practice.