A recent study funded by Curtin University and the National Health and Medical Research Council has found ‘clinically significant improvements’ in pain intensity for chronic lower back pain sufferers.
Published in one of the world’s most prestigious medical academic journals, The Lancet, the clinical trial investigated the clinical and economic benefits of Cognitive Functional Therapy (CTF) through wearable sensor biofeedback. This was compared against those living with disabling chronic low back pain who received ‘usual care’.
The study’s co-author and Curtin University’s School of Allied Health Professor Peter Kent says CTF is an ‘individualised rehabilitation approach’ designed to enhance a patient’s self-efficacy and body awareness.
“CTF is a physiotherapist-led integrated behavioural approach for individualising the management of people with disabling lower back pain once serious pathology has been excluded,” Kent says.
“It includes a multi-dimensional clinical reasoning framework to help physiotherapists negotiate clinical complexities and identify modifiable targets for care for individual patients.”
“[It allows patients] to build their capacity to perform functional activities in a way that reduces their pain-related disability and promotes self-management,” he says.
Lower back pain is considered the ‘greatest contributor’ to years lived with a disability, effecting an individual’s quality of life and ability to work as they seek on-going care and pain relief.
According to Professor Peter Kent, chronic back pain can impact ‘all aspects’ of people’s lives including their engagement in daily living, work and physical activity.
“Chronic low back can also result in high levels of distress,” he says.
“Traditional treatments such as massage, spinal manipulation, medication, injections and surgery usually only result in small to moderate effects that are often short lasting and do not change the trajectory of chronic lower back pain in most people.”
The trial was conducted in 20 physiotherapy clinics across Perth and Sydney, recruiting 492 adults who had chronic low back pain with at least ‘moderate pain-related physical activity limitations’.
Participants were provided with up to seven treatment sessions over a 12-week period, followed by a ‘booster session’ after 26 weeks. The outcomes of the patients were followed up to 12 months, with 80 per cent of participants ‘satisfied’ with the treatment and reduction of pain.
The results from the trial showed ‘clinically important’ differences between patients receiving CFT and those receiving ‘usual care’.
“All outcomes were better for the patients who received Cognitive Functional Therapy including disability, pain intensity, pain-related fear, pain catastrophising, pain self-efficacy and patient satisfaction,” Professor Kent says.
“CFT was much more cost-effective than usual care, with cost savings of $5000 per person over 12 months, mostly due to improvements in productivity.”
The study’s co-author and Curtin University’s Professor of Musculoskeletal Physiotherapy Peter O’Sullivan says the treatment differs from passive means of intervention by ‘putting the patient in charge of their condition’.
“It helps put them [the patient] understand the factors contributing to their pain, building control and confidence in their body to get back to valued activities,” he says.
“It was particularly rare and thrilling to discover that the significant reduction in pain and distress that these people living with chronic back pain experienced has remained right up to one year after trialling this new treatment.”