Lancet Rheumatol

Cognitive functional therapy may provide lasting relief for chronic low back pain

August 12, 2025

Cognitive functional therapy, with or without movement sensor biofeedback, provides sustained reductions in disability and pain intensity at 3 years compared with usual care for chronic disabling low back pain. The durability of effect is notable given the typically short-lived benefits of most interventions. Widespread implementation will require scaling clinician training and replication in diverse health systems.

Study details: The RESTORE trial was a three-arm, phase 3 randomized trial conducted in 20 Australian primary care physiotherapy clinics, enrolling adults with chronic disabling low back pain (≥3 months, moderate activity limitation, pain ≥4/10). Participants (n=492) were randomized to usual care, cognitive functional therapy (CFT) alone, or CFT plus movement sensor biofeedback. Both CFT groups received up to seven sessions over 12 weeks and a booster at 26 weeks. The 3-year follow-up assessed pain-related activity limitation (Roland Morris Disability Questionnaire [RMDQ]) and pain intensity (numeric pain rating scale).

Results: At 3 years, both CFT only (mean difference in RMDQ vs. usual care: -3.5; 95% confidence interval [CI], -4.9 to -2.0) and CFT plus biofeedback (-4.1; 95% CI , -5.6 to -2.6) demonstrated greater reduction in activity limitation than usual care. Pain intensity was also lower in both CFT groups (CFT only: -1.0; 95% CI, -1.6 to -0.5; CFT plus biofeedback: -1.5; 95% CI, -2.1 to -0.9). Differences between CFT only and CFT plus biofeedback were small and not statistically significant.

Source:

Hancock M, et al. (2025, August 5). Lancet Rheumatol. 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. https://pubmed.ncbi.nlm.nih.gov/40780241/