Background One-size-fits-all interventions reduce chronic low back pain (CLBP) a small amount. An individualised intervention called cognitive functional therapy (CFT) was superior for CLBP compared with manual therapy and exercise in one randomised controlled trial (RCT). However, systematic reviews show group interventions are as effective as one-to-one interventions for musculoskeletal pain. This RCT investigated whether a physiotherapist-delivered individualised intervention (CFT) was more effective than physiotherapist-delivered group-based exercise and education for individuals with CLBP. Methods 206 adults with CLBP were randomised to either CFT (n=106) or group-based exercise and education (n=100). The length of the CFT intervention varied according to the clinical progression of participants (mean=5 treatments). The group intervention consisted of up to 6 classes (mean=4 classes) over 6–8 weeks. Primary outcomes were disability and pain intensity in the past week at 6 months and 12months postrandomisation. Analysis was by intention-to-treat using linear mixed models. Results CFT reduced disability more than the group intervention at 6 months (mean difference, 8.65; 95% CI 3.66 to 13.64; p=0.001), and at 12 months (mean difference, 7.02; 95% CI 2.24 to 11.80; p=0.004). There were no between-group differences observed in pain intensity at 6 months (mean difference, 0.76; 95% CI -0.02 to 1.54; p=0.056) or 12 months (mean difference, 0.65; 95% CI -0.20 to 1.50; p=0.134). Conclusion CFT reduced disability, but not pain, at 6 and 12 months compared with the group-based exercise and education intervention. Future research should examine whether the greater reduction in disability achieved by CFT renders worthwhile differences for health systems and patients. Trial registration number ClinicalTrials.gov registry (NCT02145728).

中文翻译：

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认知功能疗法与基于团体的运动和教育干预慢性腰痛的比较：一项多中心随机对照试验 (RCT)

背景 一刀切的干预措施可少量减少慢性腰痛 (CLBP)。在一项随机对照试验 (RCT) 中，与手动疗法和锻炼相比，一种称为认知功能疗法 (CFT) 的个体化干预措施对 CLBP 具有更好的效果。然而，系统评价表明，对于肌肉骨骼疼痛，团体干预与一对一干预一样有效。该 RCT 调查了物理治疗师提供的个性化干预 (CFT) 是否比物理治疗师提供的基于团体的锻炼和教育对 CLBP 患者更有效。方法 206 名患有 CLBP 的成年人被随机分配到 CFT（n=106）或基于小组的运动和教育（n=100）。CFT 干预的长度根据参与者的临床进展而变化（平均 = 5 次治疗）。在 6-8 周内，小组干预最多包括 6 个班级（平均 = 4 个班级）。主要结果是随机分组后 6 个月和 12 个月过去一周的残疾和疼痛强度。使用线性混合模型通过意向治疗进行分析。结果 CFT 在 6 个月（平均差异，8.65；95% CI 3.66 至 13.64；p=0.001）和 12 个月（平均差异，7.02；95% CI 2.24 至 11.80；p=0.004 ）。在 6 个月（平均差异，0.76；95% CI -0.02 至 1.54；p=0.056）或 12 个月（平均差异，0.65；95% CI -0.20 至 1.50；p =0.134）。结论 与基于组的运动和教育干预相比，CFT 在 6 个月和 12 个月时减少了残疾，但没有减少疼痛。未来的研究应该检查 CFT 实现的更大程度的残疾减少是否为卫生系统和患者带来了有价值的差异。试验注册号 ClinicalTrials.gov 注册 (NCT02145728)。