The Lancet Rheumatology: Course of psychotherapy for low back pain remains effective for at least three years, finds trial
A type of psychotherapy called cognitive functional therapy (CFT) [1] is the first treatment for chronic disabling low back pain with good evidence that it can effectively reduce disability due to the pain for more than a year, finds a randomised controlled trial (RCT) published in The Lancet Rheumatology journal.
Low back pain is a long-term health condition for many people marked by unpredictable recurrences or pain flare ups. Interventions for low back pain have previously typically produced only small and short-term effects. A previous study published in The Lancet [2] found CFT was more effective than usual care [3] at improving self-reported physical activity participation in those with low back pain up to one year; the current trial is the first to show that these effects are sustained up to three years.
The RESTORE RCT included 492 patients with chronic low back pain in Australia, who were randomly assigned to receive eight treatment sessions of usual care, CFT, or CFT plus biofeedback (a technique using sensors to measure body functions such as heart rate and enable the patient to modify them). While those who received CFT and CFT plus biofeedback saw improvements in their physical activity participation over usual care, the difference between those receiving CFT-only and CFT plus biofeedback at three years were small and not significant, which is also consistent with the 3-month and 1-year results.
The authors say that the current trial demonstrates that CFT has long-term benefits on physical activity of those with low back pain and provides an opportunity to markedly reduce its impact if the intervention can be widely implemented. The authors highlight that implementation of CFT requires scaling up of clinician training to increase accessibility, and replication studies in diverse healthcare systems.
[1] CFT helps the patient change their mindset about the pain and self-manage via movement pattern changes and lifestyle changes.
[2] https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)00441-5/fulltext
[3] Usual care was any treatment the health provider recommended or the patient chose. It may have included painkillers, physical therapy and/or massage therapy.
The Lancet Rheumatology: Course of psychotherapy for low back pain remains effective for at least three years, finds trial
A type of psychotherapy called cognitive functional therapy (CFT) [1] is the first treatment for chronic disabling low back pain with good evidence that it can effectively reduce disability due to the pain for more than a year, finds a randomised controlled trial (RCT) published in The Lancet Rheumatology journal.
Low back pain is a long-term health condition for many people marked by unpredictable recurrences or pain flare ups. Interventions for low back pain have previously typically produced only small and short-term effects. A previous study published in The Lancet [2] found CFT was more effective than usual care [3] at improving self-reported physical activity participation in those with low back pain up to one year; the current trial is the first to show that these effects are sustained up to three years.
The RESTORE RCT included 492 patients with chronic low back pain in Australia, who were randomly assigned to receive eight treatment sessions of usual care, CFT, or CFT plus biofeedback (a technique using sensors to measure body functions such as heart rate and enable the patient to modify them). While those who received CFT and CFT plus biofeedback saw improvements in their physical activity participation over usual care, the difference between those receiving CFT-only and CFT plus biofeedback at three years were small and not significant, which is also consistent with the 3-month and 1-year results.
The authors say that the current trial demonstrates that CFT has long-term benefits on physical activity of those with low back pain and provides an opportunity to markedly reduce its impact if the intervention can be widely implemented. The authors highlight that implementation of CFT requires scaling up of clinician training to increase accessibility, and replication studies in diverse healthcare systems.
[1] CFT helps the patient change their mindset about the pain and self-manage via movement pattern changes and lifestyle changes.
[2] https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)00441-5/fulltext
[3] Usual care was any treatment the health provider recommended or the patient chose. It may have included painkillers, physical therapy and/or massage therapy.
Journal
The Lancet Rheumatology
Method of Research
Randomized controlled/clinical trial
Subject of Research
People
Article Title
Cognitive functional therapy with or without movement sensor biofeedback versus usual care for chronic, disabling low back pain (RESTORE): 3-year follow-up of a randomised, controlled trial
Article Publication Date
5-Aug-2025
COI Statement
See paper
Sustained benefits from mind and body treatment for back pain in RESTORE trial three-year follow-up
A personalised program of cognitive functional therapy (CFT) for chronic disabling low back pain produced clinically significant improvements in pain-related activity and pain intensity compared to usual care
Macquarie University
Australian research has shown that a personalised program that helps people with chronic, disabling low back pain better understand their condition and take charge of its management produces large benefits that are sustained over three years.
In the RESTORE trial, conducted at centres in Sydney and Perth, a seven-session program of cognitive functional therapy (CFT) delivered by specially trained physiotherapists significantly reduced people’s back pain and improved their function, compared with usual care.
Data just published in medical journal The Lancet Rheumatology show these improvements were largely maintained over three years of follow-up.
The persistent effect of CFT over time is a new and very important finding, says lead author Professor Mark Hancock, Professor of Physiotherapy at Macquarie University.
“This the first large, high-quality study investigating the long-term impact of CFT, and shows that it’s effective and remains effective,” says Professor Hancock.
“In fact, our previous systematic review shows there are relatively few long-term outcome studies of other treatments for chronic low back pain.”
Around 4 million Australians – one in six – live with back problems, making them the third leading cause of disease burden overall, according to the Australian Institute of Health and Welfare.
The development of CFT and its use in the RESTORE trial stemmed from what the researchers and clinicians describe as a “biopsychosocial” model of treatment, which targets the physical, psychological and social factors involved in chronic back pain and the disability it causes.
“An episode of back pain can understandably cause anxiety and fear, leading people to overprotect their body and avoid usual movements,” says study co-author Professor Peter O’Sullivan, John Curtin Distinguished Professor in the School of Allied Health Sciences at Curtin University.
“When this persists, it can set up a vicious cycle of pain sensitivity and limitation of activities,” he explains.
“CFT is about putting people in the driver’s seat: giving them the skills to manage their pain, and building their confidence to move, get active and back to living.”
Back pain is the number one cause of disability globally, says Professor Hancock, and is so common and disruptive that an intervention producing lasting reductions in pain and dysfunction offers potential for a major human and economic impact.
In Australia, an estimated $3.4 billion was spent treating and managing back problems, representing 2.2% of total health system expenditure in 2020-21.
“Things like massage, manipulation and medication can provide short-term symptom control but in the longer term, mind and body approaches that give patients the skills and confidence to self- manage, are much more effective,” says Professor Hancock.
“Our findings suggest the massive burden of low back pain could be markedly reduced if health policies supported widespread implementation of high-value, low-risk and sustained interventions like CFT, instead of less effective, short-term and potentially harmful interventions like opioids or surgery.”
The RESTORE study was led by researchers from Curtin University and Macquarie University, in partnership with Monash University, the University of Limerick, Imperial College London, the University of Southern Denmark, and the University of Western Australia. It was funded by the National Health and Medical Research Council and Curtin University.
Professor Mark Hancock is a Professor of Physiotherapy in the Macquarie University Faculty of Medicine, Health and Human Science.
Professor Peter O’Sullivan is a John Curtin Distinguished Professor in the School of Allied Health Sciences at Curtin University.
Journal
The Lancet
Method of Research
Randomized controlled/clinical trial
Subject of Research
People
Article Title
Cognitive functional therapy with or without movement sensor biofeedback versus usual care for chronic, disabling low back pain (RESTORE): 3-year follow-up of a randomised, controlled trial
Article Publication Date
5-Aug-2025
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