Australian research has shown a personalised program that helps people with chronic, disabling low-back pain better understand their condition and take charge of its management produces large benefits that are sustained over three years.
Mind and body: Professor Mark Hancock, pictured, led a low-back pain research project which has demonstrated long-term symptom control using cognitive functional therapy.
In the RESTORE trial, conducted in Sydney and Perth, a seven-session program of cognitive functional therapy (CFT) delivered by specially trained physiotherapists significantly reduced people’s back pain and improved their function, compared with usual care.
Data published in The Lancet Rheumatology shows improvements were largely maintained over three years of follow-up.
Our findings suggest the massive burden of low-back pain could be markedly reduced.
The persistent effect of CFT over time is a new and very important finding, says lead author Professor Mark Hancock, Professor of Physiotherapy at Macquarie University.
“This the first large, high-quality study investigating the long-term impact of CFT, and shows that it’s effective and remains effective,” says Professor Hancock.
“In fact, our previous systematic review shows there are relatively few long-term outcome studies of other treatments for chronic low-back pain.”
A psychological and physical approach
Around four million Australians — one in six — live with back problems, according to the Australian Institute of Health and Welfare.
The development of CFT and its use in the RESTORE trial stemmed from what the researchers and clinicians describe as a “biopsychosocial” model of treatment, which targets the physical, psychological and social factors involved in chronic back pain and the disability it causes.
Cognitive functional therapy (CFT) is a movement-based approach to low-back pain, says study co-author Peter O’Sullivan, a John Curtin Distinguished Professor in the School of Allied Health Sciences at Curtin University.
“An episode of back pain can understandably cause anxiety and fear, leading people to overprotect their body and avoid usual movements," says Professor O'Sullivan.
“When this persists, it can set up a vicious cycle of pain sensitivity and limitation of activities.
“CFT is about putting people in the driver’s seat, giving them the skills to manage their pain, and building their confidence to move, get active and back to living.
“This therapy builds trust, confidence and awareness in the body. It's done through movement control and body relaxation during graduated exposure to feared and avoided movements and activities. CFT also addresses relevant lifestyle factors."
Back pain is the number one cause of disability globally, says Professor Hancock, and is so common and disruptive that an intervention producing lasting reductions in pain and dysfunction offers potential for a major human and economic impact.
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In Australia, an estimated $3.4 billion was spent treating and managing back problems, representing 2.2 per cent of total health system expenditure in 2020-21.
“Things like massage, manipulation and medication can provide short-term symptom control but in the longer term, mind and body approaches that give patients the skills and confidence to self-manage, are much more effective,” says Professor Hancock.
“Our findings suggest the massive burden of low-back pain could be markedly reduced if health policies supported widespread implementation of high-value, low-risk and sustained interventions like CFT, instead of less effective, short-term and potentially harmful interventions like opioids or surgery.”
The RESTORE study was led by researchers from Curtin University and Macquarie University, in partnership with Monash University, the University of Limerick, Imperial College London, the University of Southern Denmark, and the University of Western Australia. It was funded by the National Health and Medical Research Council and Curtin University.
Mark Hancock is a Professor of Physiotherapy in the Macquarie University Faculty of Medicine, Health and Human Sciences.
Peter O’Sullivan is a John Curtin Distinguished Professor in the Curtin University School of Allied Health Sciences.
The Macquarie University Health Physiotherapy clinic works closely with world-leading physiotherapy researchers and offers a comprehensive range of outpatient services for back pain, including CFT. For more information: https://www.mqhealth.org.au/services/find-a-service/physiotherapy-clinic/patient-information
