OBJECTIVE: The objective was to investigate the effectiveness of cognitive functional therapy (CFT) in the management of people with chronic nonspecific low back pain (LBP) and explore the variability in available trials to understand the factors which may affect the effectiveness of the intervention.
METHODS: A systematic review with meta-analyses was conducted. Four databases were searched from inception to October 12, 2023. Randomized controlled trials investigating CFT compared with any control group in patients with nonspecific LBP were included. Mean difference and 95% CIs were calculated for pain, disability, and pain self-efficacy. Certainty of evidence was evaluated with the Grading of Recommendations Assessment, Development and Evaluation approach.
RESULTS: Seven trials were included. Low to moderate certainty of evidence was found that CFT was effective for disability at short, medium, and long term time points compared with alternate treatments, including usual care. Low to moderate certainty of evidence was found that CFT is effective for pain in the short and medium terms and probably in the long term. There was high certainty evidence CFT was effective in increasing pain self-efficacy in the medium and long terms. A single study found CFT was cost-effective compared with usual care. Variability was found in the training and implementation of CFT across the included trials, which may contribute to some heterogeneity in the results.
CONCLUSION: The results show promise in the use of CFT as an intervention likely to effectively manage disability, pain, and self-efficacy in people with chronic nonspecific LBP. The number of clinicians trained, their experience, and quality of training (including competency assessment) may be important in achieving optimal effectiveness.
IMPACT: This is the most comprehensive review of CFT to date and included investigation of between-trial differences. CFT is a promising intervention for chronic LBP and high-quality synthesis of evidence of its effectiveness is important for its clinical application.
| Discipline Area | Score |
|---|---|
| Physician |  |
| Psychologist | |
Physician rater
The challenge with meta-analyses is they are generally aggregating existing knowledge that is not new information. This strengthens the evidence.
Psychologist rater
CFT appears to be provided by physiotherapists, limiting its relevance for practicing psychologists. The results of this meta-analysis are promising and suggest the need for further research with clinicians who have more training and experience with the modality of treatment.
Psychologist rater
The limitations in the primary papers limit the usefulness of the review.
Psychologist rater
This paper provides confirmatory evidence for a treatment that is already widely assumed to be efficacious and is in general use. It isn't groundbreaking, but important nonetheless.
Dr. Hélène Bertrand (2/10/2025 12:52 PM)
Cognitive functional therapy for low back pain appears to slightly reduce pain levels and increase functional abilities. There is a much better and faster way to eradicate low back pain and increase functional ability: the SIFFT technique. Check it out at
Bertrand H, Reeves KD, Mattu R, Garcia R, Mohammed M, Wiebe E, Cheng AL. Self-Treatment of Chronic Low Back Pain Based on a Rapid and Objective Sacroiliac Asymmetry Test: A Pilot Study. Cureus. 2021 Nov 11;13(11):e19483. doi: 10.7759/cureus.19483. PMID: 34912624; PMCID: PMC8665897.
, McMaster University