title: Efficacy of classification-based cognitive functional therapy in patients with non-specific chronic low back pain: a randomized controlled trial.
abstract: BACKGROUND
  Non-specific chronic low back pain disorders have been proven resistant to change, and there is still a lack of clear evidence for one specific treatment intervention being superior to another.
  
  
  METHODS
  This randomized controlled trial aimed to investigate the efficacy of a behavioural approach to management, classification-based cognitive functional therapy, compared with traditional manual therapy and exercise. Linear mixed models were used to estimate the group differences in treatment effects. Primary outcomes at 12-month follow-up were Oswestry Disability Index and pain intensity, measured with numeric rating scale. Inclusion criteria were as follows: age between 18 and 65 years, diagnosed with non-specific chronic low back pain for >3 months, localized pain from T12 to gluteal folds, provoked with postures, movement and activities. Oswestry Disability Index had to be >14% and pain intensity last 14 days >2/10. A total of 121 patients were randomized to either classification-based cognitive functional therapy group n = 62) or manual therapy and exercise group (n > = 59).
  
  
  RESULTS
  The classification-based cognitive functional therapy group displayed significantly superior outcomes to the manual therapy and exercise group, both statistically (p < 0.001) and clinically. For Oswestry Disability Index, the classification-based cognitive functional therapy group improved by 13.7 points, and the manual therapy and exercise group by 5.5 points. For pain intensity, the classification-based cognitive functional therapy improved by 3.2 points, and the manual therapy and exercise group by 1.5 points.
  
  
  CONCLUSIONS
  The classification-based cognitive functional therapy produced superior outcomes for non-specific chronic low back pain compared with traditional manual therapy and exercise.
authors.affiliation: Physiotherapy Research Group, Department of Public Health and Primary Health Care, University of Bergen, Norway. kjartan.fersum@isf.uib.no
authors.forename: K
authors.initials: K
authors.lastname: Vibe Fersum
authors.forename: P
authors.initials: P
authors.lastname: O'Sullivan
authors.forename: J S
authors.initials: JS
authors.lastname: Skouen
authors.forename: A
authors.initials: A
authors.lastname: Smith
authors.forename: A
authors.initials: A
authors.lastname: Kvåle
mesh_terms: D000328:Adult; D059350:Chronic Pain / Q000628:therapy*; D015928:Cognitive Behavioral Therapy / Q000379:methods; D004185:Disability Evaluation; D005081:Exercise Therapy / Q000379:methods; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D026201:Musculoskeletal Manipulations / Q000379:methods; D010147:Pain Measurement / Q000379:methods; D026741:Physical Therapy Modalities; D011187:Posture / Q000502:physiology; D016896:Treatment Outcome