Impact of exercise therapy with/without cognitive functional therapy on pain, Function, and biopsychosocial factors in chronic nonspecific low back pain

Abstract

Background: Exercise therapy (ET) is a well-established treatment for chronic low back pain. However, the combined effect of ET with cognitive functional therapy (CFT) on chronic nonspecific low back pain (CNLBP) remains under-investigated. This study investigated how these interventions, used together or separately, affected individuals with CNLBP.

Methods: Sixty females (40-60 years) were allocated to ET, ET + CFT, and control groups. Both intervention groups received 24 sessions (3x/week) over 8 weeks. Functional disability, pain, lumbar pelvic motor control, and anxiety/depression were assessed before and after the intervention.

Results: Fifty-one participants completed the study. The ET + CFT group showed greater improvements compared to both ET and control in all measured areas (functional disability, pain, motor control, anxiety/depression) (P < 0.05). However, both ET and ET + CFT groups improved significantly compared to control for all variables (P < 0.05).

Conclusions: Following eight weeks of intervention, both ET and ET + CFT improved functional disability, pain, lumbar pelvic motor control, and biopsychosocial indicators in individuals with CNLBP. Notably, while the combined intervention group (ET + CFT) showed greater improvements across most outcomes, it was significantly different from the exercise-only group only on the Kinesiophobia scale. These findings suggest that cognitive functional therapy may enhance the effectiveness of exercise therapy by addressing psychological factors, such as fear of movement, that contribute to pain and disability in CNLBP.

Keywords: Chronic low back pain; Cognitive functional therapy; Exercise intervention; Functional ability; Manual therapy; Neuromuscular exercise; Women's health.