
Cognitive Functional Therapy
Low back pain is a very common condition among the adult population. In the United States, it is the second greatest cause of disability. It is estimated that between 10-17% of adults have a back pain episode each year. For 90% of the patients with an acute episode of back pain, pain resolves in about 2-4 weeks. Yet in the year following a first episode of low back pain, the pain recurs in a staggering 60-80% of patients. Eighty five percent of chronic low back pain disorders have no known diagnosis leading to a classification of “non-specific chronic low back pain”. Even when a specific radiological diagnosis is reached, the underlying pain mechanism cannot always be assumed. It is now widely accepted that chronic low back pain disorders are multi-factorial in nature, and that proper and effective management requires the practitioner to adopt a bio-psycho-social approach.
Cognitive functional therapy (CFT) incorporates neuro-physiological, psychological, and social factors in addition to the conventional patho—anatomical and physical factors in the comprehensive evaluation of patients with persistent back pain. The development of this approach has gained momentum in the field of physical therapy internationally in recent years. Researchers have recognized that people with chronic or persistent back pain (PBP) have different degree of influence of the above factors and therefore establish classification system to better categorize patients with PBP in order to ensure appropriate management.
In a recent study by Fersum et al, it was concluded that CFT is superior to conventional physical therapy management using manual therapy and exercises. In the same study, the CFT group of patients received weekly therapy sessions for the first 2-3 weeks and then progressed to every 2-3 weeks for a total of 12-week intervention period. The CFT group showed better overall outcomes in pain intensity, functional disability, fear avoidance behavior, less sick leave and better patient satisfaction. The CFT group also required much less professional care after the program at the end of the first 12 months.
