The Lancet Rheumatology: Course of psychotherapy for low back pain remains effective for at least three years, finds trial

The Lancet

LinkedInWeChatBlueskyMessageWhatsAppEmail

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

DOI

10.1016/S2665-9913(25)00135-3/fulltext 

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

LinkedInWeChatBlueskyMessageWhatsAppEmail

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

 

Global network taps tree rings to study impact of tropical drought

University of Arizona

LinkedInWeChatBluesky

Email

A new study leveraging 20,000 tree-ring records and nearly 150 scientists' contributions from across the globe shows that, while droughts appear to have had a modest impact on tropical tree growth in the past, that may not be the case for long. 

The research team calculated that, on average across the tropics, trees grew 2.5 percent less during drought years compared to years with normal or above-average precipitation. Surprisingly, the researchers also found an almost complete recovery in the year following the drought. However, that resilience, they warn, could weaken when droughts occur more frequently and become more intense – particularly within drier, semi-arid regions of the tropics.

Few comprehensive studies on tropical tree rings have been published, largely because year-long warm and moist conditions were thought to prevent regular annual ring formation. But scientists have come to understand that some tropical tree species and their rings can chart water availability, explained Valerie Trouet, co-author on the study and professor of dendrochronology at the University of Arizona's Laboratory of Tree-Ring Research.

"Tropical dendrochronology has long been deemed impossible or at least too complex to use for synthesis science," said Trouet. "In this paper, we use the largest network of tropical tree-ring chronologies yet, to do exactly that, to synthesize the impact of drought on woody tree growth in tropical forests."

"Until now, we didn't know to what extent stem growth in tropical forests decreases during droughts," said Pieter Zuidema, lead author on the paper and professor at the Netherland's Wageningen University & Research. "With our new network of tree-ring records, we were able to calculate the effect of droughts on stem growth across the tropics for the first time."

Clogging the carbon sink

Tropical forests and woodlands are key components of the global carbon cycle, specifically in their role in sequestering CO2 – often for decades. During drought, tree growth usually slows, which reduces the amount of carbon stored. 

To understand and predict the risks that droughts pose for the long-term capture of carbon in tropical vegetation, the researchers used the largest collection of tropical tree-ring data to date: more than 20,000 tree-ring series from nearly 500 locations in 36 countries. 

The tree-ring data were collected at 483 locations spread across the tropics – from wet and warm Amazonian forests to dry forests in southern Africa and cooler Asian mountain forests. 

The researchers determined the driest years since 1930 for all locations, then calculated how much narrower the tree rings were during those years compared to normal years. They also measured the width of tree rings in the two years following a drought. 

Focusing their analysis on the top 10 percent of driest years, the research team observed stem growth of tropical trees decreased on average by 2.5 percent. For the top 5 percent of extreme years, that global average of growth decreased even further, down to 3.2 percent, explained Flurin Babst, a co-author on the study who helped design and run the analysis and an assistant professor in the U of A School of Natural Resources and the Environment. 

"An average growth reduction of 3.2 percent under drought may seem small," said Babst. "But given the dominant role that tropical forests and woodlands play in the global carbon cycle, the impacts of intensifying drought on the land carbon sink could be substantial. This is relevant for the many initiatives worldwide that use tropical trees as carbon reservoirs to offset anthropogenic CO2 emissions."

In drier, semi-arid tropical regions, the average tree growth slowed down even further, by roughly 10 percent in a quarter of the locations included in the study. 

"This happened mainly in hot and dry regions, such as in northeastern Brazil and southern Africa," Zuidema said. "The effects of droughts can be more extreme there because trees shed their leaves quickly and the soil retains less moisture. In wetter areas, such as Amazonian forests, the effects were weaker." 

The researchers warn that stem growth resilience could weaken when droughts occur more frequently and become more intense – something they have witnessed within the past few decades in research locations within the study. 

"Recent droughts have already caused stronger reductions in stem growth compared to earlier droughts. It gets harder for trees to recover," Zuidema said. "We expect that ongoing climate change will only exacerbate this effect."

Reduced tree growth has widely been associated with higher tree mortality, and while this study did not directly quantify tree mortality at the 483 tree-ring locations, the team used existing research to estimate that drought increased the normal tropical tree mortality rate by 0.1 percent. 

"Again, 0.1 percent is not a huge number," said Babst. "But considering the vast area that tropical forests and woodlands occupy, this increase in tree mortality leads to a notable amount of biomass that dies, decays, and releases CO2 back into the atmosphere. More research is clearly needed to better quantify this feedback."

A tropical tree-ring network

The study is the result of a recently formed network of tropical tree-ring studies, which aims to unite data from tree-ring studies across the tropics to better understand how tropical trees respond to current and future climatic conditions.

"Hundreds of tree-ring studies have been conducted on tropical trees over the past few decades," said Peter Groenendijk, co-author on the study and an assistant professor at University of Campinas in Brazil. "However, this is the first time those data have been compiled for large-scale analysis. We are trying to understand the past in order to predict the future."

Zuidema, Groenendijk, Trouet and Babst are the initial founders of the network and continue to serve as the core members responsible for its overall management. Today, the initiative has grown to include over 170 collaborators, contributing nearly 500 ring-width chronologies from more than 30 countries across all tropical continents, representing over 139 tree species. 

---

Journal

Science

DOI

10.1126/science.adq6607 

Article Title

Pantropical tree rings show small effects of drought on stem growth

 

Urbanization linked to a 43 per cent drop in pollinating insects

University of Sheffield

Faceboo

XLinkedInWeChatBlueskyMessageWhatsApp
Email

 

image: 

Marmalade Hoverfly. Credit: Stuart Campbell

view more 

Credit: Stuart Campbell

*Images available*

• Urban landscapes support 43 per cent fewer pollinator species according to a new study from the University of Sheffield

• A research team conducted a comparative study at allotment sites in three major cities across England and found that those in more urbanised areas saw the highest decline in insect pollinator species

• The study found that relative to bees, nocturnal moths and hoverflies - which can be just as important for pollination - are particularly sensitive to the effects of urbanisation

• Researchers warn that more needs to be done to understand and conserve pollinating insects that are vulnerable to the effects of habitat loss through urbanisation

• Pollinating insects are vital for the reproduction of up to 90 per cent of wild flowering plant species and many crop species

Increasing urbanisation is linked to a decline in crucial pollinator populations, including nocturnal moths, hoverflies, and bees, according to a new study from the University of Sheffield.

The research, which paints a concerning picture for biodiversity, is published today (August 6, 2025) in the Royal Society's flagship biological research journal.

On allotment sites in Sheffield, Leeds and Leicester, a research team sampled pollinator species in a range of urban settings from city centres to more suburban areas. They found that there was a decline in species abundance and richness - up to 43 per cent - on allotments situated in more built-up areas.

The findings suggest that a wide range of pollinators are under threat in urban landscapes, and the researchers warn that more needs to be done to understand and conserve pollinating insects that are vulnerable to the effects of habitat loss through urbanisation.

Emilie Ellis, lead author of the study from the University of Sheffield’s School of Biosciences, said: “The scale of the threat to many pollinator species remains relatively unknown due to a global focus on bees. However moths and hoverflies are just as important for our ecosystems, and our results show they may be particularly vulnerable in urban habitats.

“Pollinating insects are vital for the reproduction of up to 90 per cent of wild flowering plant species and many crop species. As urbanisation causes more habitat loss, insect communities suffer and ecosystems become fragile. Our study identifies some of the features of urban greenspaces that are key to preserving and growing habitats for pollinators that are vulnerable to environmental change.”

The study shows that the cause of reduced pollinator diversity and abundance varies depending on the species, but is primarily driven through a reduction in the tree canopy and semi-natural habitat that form part of the green spaces found in our cities.

Jill Edmondson, senior author from the University of Sheffield’s School of Biosciences, said: “Allotments form greenspace oases in the urban landscape, with a rich mix of crops and flowers species to support pollinator communities, but, as the area of impervious surface (or the concrete, tarmac and buildings that often form the urban landscape we recognise) around allotments increased there was less habitat available for all pollinator groups. This may have consequences for crop pollination and ultimately yield in more urban allotments. 

“Our study demonstrates the importance of urban semi-natural spaces for insects, which we rely on, not just to make our gardens beautiful, but to support worldwide farming systems.”

Stuart Campbell, co-author from the University of Sheffield’s School of Biosciences, said: “All pollinating insects struggle to find suitable food and habitat in cities, but there haven’t been many studies directly comparing different groups. The greater sensitivity of hoverflies and moths to urbanisation might be due to their ecological requirements. 

“All of these species need flowers to feed on, but moths also require tree and shrub canopies, and food plants for their caterpillars, while many hoverflies require stagnant water to breed. These are all habitat characteristics that can be much harder to find in more heavily built up areas, and we will need to consider these features in order to conserve such a diverse group of insects for future generations.”

The team say the findings should underpin a more nuanced approach to pollinator conservation, and point out that more engagement with urban planners, stakeholders and policymakers is required to successfully protect the habitat features needed to support and sustain diverse pollinating insect communities in urban areas.

Emilie Ellis was funded by a PhD Scholarship from the Grantham Centre for Sustainable Futures with Jill Edmondson and Stuart Campbell as supervisors. Emilie is currently a postdoctoral associate with the Research Centre for Ecological Change at the University of Helsinki. 

The University of Sheffield’s School of Biosciences is working to solve some of the most pressing global challenges, from climate change and cancer, to sustainability and healthy ageing. Join us to study courses that cover the full breadth of biology, from molecular and cell biology, genetics, development, human physiology and pharmacology through to evolution, ecology, biodiversity conservation and sustainability.

ENDS

Poplar Hawkmoth. Credit: Emilie Ellis

Credit

Emilie Ellis

The University of Sheffield

The University of Sheffield is a leading Russell Group university, with a world-class reputation, ranked within the Top 100 universities in the world (QS World University Rankings 2026 and Times Higher Education World University Rankings 2025). Over 30,000 students from 150 countries study at Sheffield and in a truly global community, they learn alongside over 1,500 of the world’s leading academics.

Sheffield’s world-shaping research feeds into its excellent education. Students learn at the leading edge of discovery from researchers who are tackling today’s biggest global challenges. 

At its core, Sheffield is a place where independent thinkers can come together in pursuit of a shared ambition. To ask bold questions, push boundaries, and make a difference. This is what makes the University of Sheffield one of the best in the world.

From the first documented use of penicillin as a therapy in 1930, to building Europe’s largest research-led manufacturing cluster, Sheffield’s inventive spirit and top quality research environment sets it apart. 

Current research partners include Boeing, Rolls-Royce, Unilever, AstraZeneca, GlaxoSmithKline, Siemens and Airbus, as well as many government agencies and charitable foundations.

Sheffield was voted University of the Year in 2024 at the Whatuni Student Choice Awards - the largest annual university awards in the UK voted for exclusively by students. The award reflects a commitment to world-class education and an outstanding student experience. Its Students' Union, which is home to more than 350 societies and clubs, was also named Best Students’ Union in the UK for seven consecutive years between 2017-2024.

Over 300,000 Sheffield alumni from 205 different countries make a significant influence across the world, with six Nobel Prize winners included amongst former staff and students.

---

Journal

Proceedings of the Royal Society B Biological Sciences

DOI

10.1098/rspb.2025.0102 

Article Publication Date

6-Aug-2025

Robot crab reveals how males compete in claw-waving contest

University of Exeter

FacebookXLinkedInWeChatBluesky

MessageWhatsAppEmail

 

image: 

Wavy Dave and a fiddler crab waving their claws. Credit Joe Wilde (1)

view more 

Credit: Joe Wilde

A robot crab has helped scientists understand how male fiddler crabs compete over females.

Male fiddler crabs have one oversized claw, and they attract females by standing outside their burrow and waving it.

In the new study, a robot crab – nicknamed Wavy Dave – waved its claw on a mudflat teeming with male fiddler crabs.

When the robot was waving, real males waved for longer in response, and they were less likely to retreat into their burrows – especially when the robot had a small claw.

The study – led by the Centre for Research in Animal Behaviour (CRAB) at the University of Exeter – suggests male crabs notice the behaviour of rivals and can adjust their behaviour in response.

“We know many animals adjust their sexual displays if rivals are nearby, but less is known about how they react to the actual displays themselves,” said Dr Joe Wilde, now at BioSS.

“If you own a shop and your rivals start selling things really cheaply, you might have to change how you run your business.

“The same might be true for males signalling to attract females – and our study suggests males do indeed respond to competition.

“Our findings reveal the subtle ways in which these crabs adjust their behaviour to compete in a dynamic environment, investing more in signalling when it is likely to be most profitable.”

Female fiddler crabs prefer males with a larger claw, and those that wave their claw quickly.

In the study – carried out in southern Portugal – males waved for longer when the robot was waving, but they did not wave faster.

Commenting on this, Dr Wilde said the crabs might interpret a waving rival as a signal that a female is around – but wait to see the female themselves before committing their full effort.

If a female enters a male’s burrow, the male fertilises her eggs. Once the eggs have hatched, the larvae float away to sea.

Males also retreat into their burrow at intervals for a variety of other possible reasons – including avoiding predators and fights with rivals, resting and wetting their gills.

‘Wavy Dave’ under attack

Thousands of crabs live on the mudflats where the study was conducted.

For each test, the robot crab was set up 30cm from a real male’s burrow, with two cameras recording.

The results show that males were less likely to compete when a rival had a larger claw, possibly because they expected to lose or were fearful of being attacked.

However, some crabs took issue with the robotic intruder.

“The females realised he was a bit odd, and some of the males tried to fight him,” said Dr Wilde.

“One male broke Wavy Dave by pulling off his claw. We had to abandon that trial and reboot the robot.”

Lockdown ‘pipedream’

Dr Wilde said Wavy Dave began as a “pipedream” during the Covid lockdown.

At the time, Dr Wilde was learning about 3D printing, and he happened to see that someone had created 3D scans of fiddler crabs and made them freely available.

He found a 3D printer to make a model, and taught himself enough robotics to make a crab that waved its claw. He then developed an app to control the crab via Bluetooth signals.

Dr Wilde’s work was funded by the Natural Environment Research Council GW4+ Doctoral Training Partnership.

The paper, published in the journal Proceedings of the Royal Society B, is entitled: “Biomimetic robots reveal flexible adjustment of sexual signalling in a wild invertebrate.”

Male fiddler crabs

Credit

Joe Wilde

Robot waving examples [VIDEO] | 

---

Journal

Proceedings of the Royal Society B Biological Sciences

DOI

10.1098/rspb.2025.1570 

Article Title

Biomimetic robots reveal flexible adjustment of sexual signalling in a wild invertebrate

Article Publication Date

5-Aug-2025