Facts: About the study
500 people over 18 living in Australia were included in the study. They were randomly assigned to receive either standard care or cognitive functional therapy, CFT. The average age was 47 years and 60 percent were women.
During 12 weeks, the CFT group saw a specially trained physiotherapist on seven occasions during 12 weeks. Everyone also had a sensor attached to their body that recorded their movements. Half of the participants in the CFT group also received feedback from the motion sensor.
The CFT patients had to tell about their pain and problems and how they affected them and also how they were doing in life in general with work, relationships, diet and physical activity. Together, physiotherapists and patients identified if there were certain movements or things that the patient avoided for fear of pain.
The treatment included that the patients should challenge the fear and try to find ways to live without limiting themselves.
After 12 weeks, those who received CFT treatment showed better results in terms of pain and less avoidance behaviors in terms of movement. They were also more satisfied with the treatment than the group that received standard care.
The positive results remained to a large extent after one year. According to the researchers’ calculations, the treatment was also cost-effective compared to standard care, including through fewer sick leave.
Source: The Lancet
Pain in the lower back is common, around 80 percent are estimated to have it at some point in their lives. For some it is short-lived and manageable, but for others the pain means great suffering and limitations.
“It often starts with avoiding certain movements and activities that hurt, which can lead to a vicious circle where you become more and more afraid to use your body and do certain things,” says Eva Skillgate, naparapat and professor at Sophiahemmet University.
Focus on the individual
In recent years, there has been increasing support for the fact that a person-centred treatment for long-term back pain can help. A treatment that focuses on teaching the patient to better understand why they are in pain and supporting them in how they can better manage their pain with both exercise and lifestyle changes.
— I think that many physiotherapists try to work like this, but one problem is that the time is not always enough. It’s a shame because many people with chronic back pain end up in healthcare and cost society a lot of money and mean a lot of suffering for the patient, says Eva Rasmussen Barr, physiotherapist and researcher at the Karolinska Institute in back pain.
In a recent Australian study, published in the journal Lancet, 500 participants who all had low back pain for more than three months were randomly assigned to one of three groups. Group one had to seek traditional treatment, which could mean a visit to a physiotherapist, chiropractor, medicine or surgery.
The two other groups had twelve occasions to see a physiotherapist who was specially trained in cognitive functional therapy (CFT) – behavioral medicine. In that treatment, the patients were told about their pain and problems and how they affected them. They identified movements or activities that the patient avoided for fear of pain.
Challenge the fear
The patients were also encouraged to challenge the fear and try to find ways to live without limiting themselves physically and socially. Participants were also made to wear sensors that recorded their movement patterns. One group also received feedback from the sensors and to see if certain movements and pain experiences were connected.
After 13 weeks, people in the CFT groups fared significantly better than those randomized to standard care. 60 percent of those who received CFT stated that their activity limitations decreased compared to 19 percent in the standard group. Those who received CFT also experienced less pain than others. However, the feedback from the motion sensor did not play any role in the result.
Physically and mentally
— The study, which is very well done, shows the importance of primary care taking a holistic approach to patients. The social, the psychological and the physical are connected, not least in the case of long-term pain, says Eva Skillgate, who herself has met many patients with disabling back pain.
— It is important to dare to believe that your back will hold and try to remain active – physically, socially and through work.
Furthermore, the improvements that the patients experienced persisted after one year.
— It is very unusual to have such long-lasting effects of treatment for this patient group, says Eva Skillgate.
— This shows the importance of the patient feeling listened to and receiving an individual plan with good coaching. Many end up in a spiral of drugs and investigations.