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FOTO Rehab Outcomes Blog

Cognitive Functional Therapy and Nonspecific Low Back Pain

As a curious soul, I appreciate qualitative studies that shed light on how we think and feel. This study investigates the physical therapists' perspectives of cognitive functional training.

chronic-back-pain-cognitive-functional-trainingTreating and managing individuals who have persistent low back pain can be quite challenging. One of the reasons I am changing my practice focus truly has to do with how individuals in my local region who have persistent back pain are treated. 

As this study highlights, I am not alone in my thoughts about the difficulty in treating these individuals. It's quite difficult to work with these individuals who have strong biomedical beliefs. The main reason, in my opinion, is the fact that all the interacting health care professionals are not on the same page providing the same message to these patients.

Since I know that the majority of patients seeking services for physical therapy will have low back pain as their main reason for services, I thought this study would be helpful for the majority of physical therapists. Often times departmental strategies are implemented without considering how the strategy will be perceived by the clinicians. This study sheds light on the perception of physical therapists who underwent cognitive functional therapy training and implemented it into practice.

The abstract is included below for you to review.

The perspectives of physiotherapists on managing nonspecific low back pain following a training programme in cognitive functional therapy: A qualitative study.




It has long been acknowledged that nonspecific chronic low back pain (NSCLBP) is associated with a complex combination of biopsychosocial (BPS) factors, and recent guidelines advocate that the management of back pain should reflect this multidimensional complexity. Cognitive functional therapy (CFT) is a behaviourally oriented intervention that targets patients' individual BPS profiles. Although the efficacy of CFT has been demonstrated in primary care, little evidence exists about the training requirements of this approach.


Qualitative semistructured interviews were conducted with 10 physiotherapists working in primary care, who had undergone a formal training programme in CFT. A purposive sampling method was employed to seek the broadest perspectives. Thematic analysis was used to analyse the interview transcripts and capture the emergent themes.


Five main themes emerged: (i) the learning challenge; (ii) self-reported changes in confidence; (iii) self-reported changes in communication practice; (iv) self-reported changes in attitudes and understanding; (v) the physiotherapists felt that CFT was more effective than their usual approach for NSCLBP but identified barriers to successful implementation, which included a lack of time and difficulties in engaging patients with strong biomedical beliefs.


The study suggested that training in CFT has the capacity to produce self-reported changes in physiotherapists' attitudes, confidence and practice. The provision of such training has implications in terms of time and costs; however, this this may be warranted, given the physiotherapists' strong allegiance to the approach compared with their usual practice.

 2018 Nov 23. doi: 10.1002/msc.1370. [Epub ahead of print]

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