The Effect of Cognitive Functional Therapy on Patients With Non-specific Chronic Low Back Pain

NCT ID: NCT02145728

Last Updated: 2018-12-12

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

208 participants

Study Classification

INTERVENTIONAL

Study Start Date

2014-05-31

Study Completion Date

2018-12-31

Brief Summary

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The purpose of this study is to evaluate whether individual cognitive functional therapy (CFT), when compared to group exercise classes is effective in reducing pain and disability in patients with non-specific chronic low back pain.

Detailed Description

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A multi-centre randomised study with 6 month, 12 month and 36 month follow up will be used. Patient with non- specific chronic low back pain will be assessed for eligibility. The patients fitting the inclusion criteria will be randomised to receive either the individual CFT or the group classes consisting of education and exercise. Participants' pain, disability, socio-economic status, beliefs, fear, catastrophizing, self-efficacy, general health, stress levels, as well as number and cost of treatments will be evaluated using a range of outcome measures at the start and on completion of the treatment. Patients will receive another copy of the questionnaires in the post at 6 month, 12 months and 36 months after treatment to reassess clinical outcomes. If a participant does not respond to follow-up, they will be telephoned to ask if they wish to complete the questionnaires.

Conditions

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Chronic Low Back Pain

Keywords

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Non-specific chronic low back pain Cognitive functional therapy Exercise classes

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Outcome Assessors

Study Groups

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Individual Cognitive Functional Therapy

The intervention being tested has four main components: (1) a cognitive component, for each patient, their vicious cycle of pain will outlined in a diagram based on their findings from the examination and the Orebro Musculoskeletal Pain Screening Questionnaire; (2) specific movement exercises designed to normalize maladaptive movement behaviours; (3) targeted functional integration of activities in their daily life previously, reported to be avoided or provocative by the patient; and (4) a physical activity and lifestyle programme.

Group Type EXPERIMENTAL

Individual Cognitive Functional Therapy

Intervention Type BEHAVIORAL

Cognitive functional therapy (CFT) is a novel, patient centred behavioural intervention which addresses multiple dimensions in non-specific chronic low back pain (NSCLBP). It combines a functional behavioural approach of normalising provocative postures and movements while discouraging pain behaviours, with cognitive restructuring of the NSCLBP problem.

Group Exercise Classes

6 classes will take place in total. The class has 3 components each week. First, a 30 minute talk and discussion on chronic pain, and some tips for participants. Second, a 40 minute exercise circuit, involving aerobic exercise, and gentle stretching and strengthening exercises. Finally, a 5 minute relaxation/mindfulness session will take place at the end. The total time involved is approximately 1 hour and 15 minutes.

Group Type ACTIVE_COMPARATOR

Group Exercise Classes

Intervention Type BEHAVIORAL

Each class involves a combination of education, exercise and relaxation/mindfulness. The education topics include pain and the nervous system, posture and ergonomics, exercise and relaxation and sleep. The exercise component includes 10 stations of a combination of aerobic, strength and flexibility exercises. These will be walking/jogging on the spot, mini-squats, sit to stands, wall push ups, bridging, step-ups and a combination of leg and low back stretches. The relaxation/mindfulness component will take place at the end of each class and will involve breathing and relaxation of the body.

Interventions

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Individual Cognitive Functional Therapy

Cognitive functional therapy (CFT) is a novel, patient centred behavioural intervention which addresses multiple dimensions in non-specific chronic low back pain (NSCLBP). It combines a functional behavioural approach of normalising provocative postures and movements while discouraging pain behaviours, with cognitive restructuring of the NSCLBP problem.

Intervention Type BEHAVIORAL

Group Exercise Classes

Each class involves a combination of education, exercise and relaxation/mindfulness. The education topics include pain and the nervous system, posture and ergonomics, exercise and relaxation and sleep. The exercise component includes 10 stations of a combination of aerobic, strength and flexibility exercises. These will be walking/jogging on the spot, mini-squats, sit to stands, wall push ups, bridging, step-ups and a combination of leg and low back stretches. The relaxation/mindfulness component will take place at the end of each class and will involve breathing and relaxation of the body.

Intervention Type BEHAVIORAL

Eligibility Criteria

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Inclusion Criteria

* Aged between 18 and 75
* Chronic low back pain greater than 6 months duration
* Score greater than 14% for disability on Oswestry Disability Index (ODI)
* Independently mobile (with or without aids), to be capable of participating in a rehabilitation programme

Exclusion Criteria

* Primary pain area is not the lumbar spine (from T12-buttocks)
* Leg pain as the primary problem (nerve root compression or disc prolapse with true radicular pain/radiculopathy, lateral recess/central or spinal stenosis with primary leg pain)
* \<6 months post lumbar spine or lower limb or abdominal surgery
* Pain relieving procedures such as injection based therapy (e.g epidurals) and day case procedures (e.g rhizotomy) in the last 3 months
* Pregnancy
* Rheumatologic/inflammatory disease (e.g. rheumatoid arthritis (RA), ankylosing spondylitis (AS), psoriatic arthritis, lupus, scheuermann's disease)
* Progressive neurological disease (e.g. multiple sclerosis (MS), parkinson's disease (PD), motor neuron disease (MND)
* Unstable cardiac conditions
* Red flag disorders like malignancy/cancer, acute traumas like fracture (\<6 months ago) or infection, spinal cord compression/cauda equina
Minimum Eligible Age

18 Years

Maximum Eligible Age

75 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Curtin University

OTHER

Sponsor Role collaborator

KU Leuven

OTHER

Sponsor Role collaborator

Mayo General Hospital, Ireland

OTHER

Sponsor Role collaborator

Health Service Executive, Ireland

OTHER

Sponsor Role collaborator

University of Limerick

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Dr Kieran O' Sullivan, PhD

Role: STUDY_DIRECTOR

University of Limerick

Mary O'Keeffe, BSc Physio

Role: PRINCIPAL_INVESTIGATOR

University of Limerick

Prof. Peter O'Sullivan, Professor

Role: PRINCIPAL_INVESTIGATOR

Curtin University

Dr Norelee Kennedy, PhD

Role: PRINCIPAL_INVESTIGATOR

University of Limerick

Prof. Wim Dankaerts, Professor

Role: PRINCIPAL_INVESTIGATOR

KU Leuven

Locations

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Ballina Primary Care Centre

Mayo, Connacht, Ireland

Site Status

Claremorris Primary Care Centre

Mayo, Connacht, Ireland

Site Status

Mayo General Hospital

Mayo, Connacht, Ireland

Site Status

Countries

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Ireland

References

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O'Sullivan P. It's time for change with the management of non-specific chronic low back pain. Br J Sports Med. 2012 Mar;46(4):224-7. doi: 10.1136/bjsm.2010.081638. Epub 2011 Aug 4. No abstract available.

Reference Type BACKGROUND
PMID: 21821612 (View on PubMed)

Vibe Fersum K, O'Sullivan P, Skouen JS, Smith A, Kvale A. Efficacy of classification-based cognitive functional therapy in patients with non-specific chronic low back pain: a randomized controlled trial. Eur J Pain. 2013 Jul;17(6):916-28. doi: 10.1002/j.1532-2149.2012.00252.x. Epub 2012 Dec 4.

Reference Type RESULT
PMID: 23208945 (View on PubMed)

O'Keeffe M, O'Sullivan P, Purtill H, Bargary N, O'Sullivan K. Cognitive functional therapy compared with a group-based exercise and education intervention for chronic low back pain: a multicentre randomised controlled trial (RCT). Br J Sports Med. 2020 Jul;54(13):782-789. doi: 10.1136/bjsports-2019-100780. Epub 2019 Oct 19.

Reference Type DERIVED
PMID: 31630089 (View on PubMed)

O'Keeffe M, Purtill H, Kennedy N, O'Sullivan P, Dankaerts W, Tighe A, Allworthy L, Dolan L, Bargary N, O'Sullivan K. Individualised cognitive functional therapy compared with a combined exercise and pain education class for patients with non-specific chronic low back pain: study protocol for a multicentre randomised controlled trial. BMJ Open. 2015 Jun 1;5(6):e007156. doi: 10.1136/bmjopen-2014-007156.

Reference Type DERIVED
PMID: 26033941 (View on PubMed)

Other Identifiers

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MGH-14-UL

Identifier Type: -

Identifier Source: org_study_id