• Kasper Ussing, Per Kjaer, Anne Smith, Peter Kent, Rikke K Jensen, Berit Schiøttz-Christensen, and Peter Bruce O'Sullivan.
• Spine Center of Southern Denmark, Lillebaelt Hospital, Middelfart, Denmark.
• Pain Med. 2020 Oct 1; 21 (10): 2061-2070.

BackgroundEffective, inexpensive, and low-risk interventions are needed for patients with nonspecific persistent low back pain (NS-PLBP) who are unresponsive to primary care interventions. Cognitive functional therapy (CFT) is a multidimensional behavioral self-management approach that has demonstrated promising results in primary care and has not been tested in secondary care.ObjectiveTo investigate the effect of CFT and compare it with usual care for patients with NS-PLBP.DesignCase-control study.SettingA secondary care spine center.SubjectsThirty-nine patients received a CFT intervention and were matched using propensity scoring to 185 control patients receiving usual care.MethodsThe primary outcome was Roland Morris Disability Questionnaire (0-100 scale) score. Group-level differences at six- and 12-month follow-up were estimated using mixed-effects linear regression.ResultsAt six-month follow-up, a statistically significant and clinically relevant difference in disability favored the CFT group (-20.7, 95% confidence interval [CI] = -27.2 to -14.2, P < 0.001). Significant differences also occurred for LBP and leg pain, fear, anxiety, and catastrophizing in favor of CFT. At 12-month follow-up, the difference in disability was smaller and no longer statistically significant (-8.1, 95% CI = -17.4 to 1.2, P = 0.086). Differences in leg pain intensity and fear remained significantly in favor of CFT. Treatment satisfaction was significantly higher in the CFT group at six- (93% vs 66%) and 12-month (84% vs 52%) follow-up.ConclusionsThese findings support that CFT is beneficial for patients with NS-PLBP who are unresponsive to primary care interventions. Subsequent randomized controlled trials could incorporate booster sessions, which may result in larger effects at 12-month follow-up.© The Author(s) 2020. Published by Oxford University Press on behalf of the American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

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