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Monday, 8 May 2023
A new study has offered conclusive evidence that a personalised care approach for back pain can have significant benefits. The multi-centre trial based in Australia was led by Associate Professor Peter Kent at Curtin University in Perth, and Professor Mark Hancock at Macquarie University.
Long-term sufferers of back pain experienced less pain, along with saving thousands of euros per person, in a recent study conducted by an international consortium of researchers, including Professor Kieran O’Sullivan, associate professor of physiotherapy at UL.
The new approach, called Cognitive Functional Therapy (CFT), offered personalised care to help people with back pain ‘join the dots’ regarding their own pain triggers, so that they could make sense of their pain.
Thereafter, people with pain were helped to regain confidence in how to move, as well as putting together a plan to improve their general health.
Published today in leading medical journal The Lancet, the research found large clinically significant improvements in pain intensity and disability among almost 500 people who had been seeking help for their pain for an average of four years before trying the new approach.
This randomised clinical trial is the third, and largest so far, to show the benefits of CFT for back pain. One of the previous trials in Ireland was led by Professor O’Sullivan who is a co-author on the latest research that has just been published.
According to Professor O’Sullivan, the initial Irish trial had shown similar significant benefits from this personalised approach, but questions remained about whether the benefit was cost-effective.
The latest trial confirms that the approach is highly cost-effective, with the treatment delivering a healthcare and work productivity saving of more than $5,000 Australian dollars per person.
“It has been clear for decades that back pain is influenced by not only physical factors, such as strength and posture, but also psychological factors such as worries and mood, social factors such as work and family commitments, and lifestyle factors such as sleep,” explained Professor O’Sullivan.
“However, many people seeking care for back pain still receive mostly traditional, more passive approaches – including massage, spinal manipulation, medication, and injections. In contrast, in this approach the person with pain is coached to better understand the unique set of factors contributing to their pain, and then trained to self-manage their pain and health over a few months.”
According to Professor O’Sullivan there are several key implications from this latest trial.
“First, this is yet another reminder that back pain treatment requires us to address both physical and non-physical factors. Second, the precise movements and health advice used to help each person varied according to what they needed.
“For some, there may be a large focus on making them more active, as they were worried they might damage themselves, or concerned about something that had been reported on an MRI scan - for others, the focus may be more on their sleep, stress or general health.
“This is what makes this personalised approach to back pain unique. While this is initially time-consuming, there is great value – both for the patient and for the economy – in transforming back pain care in this way.”
Back pain remains the leading cause of disability worldwide. Looking to how this can be implemented for the millions of people affected by back pain, Professor O’Sullivan notes that this approach required a considerable degree of training - over five months – even among already experienced physiotherapists. Furthermore, the rehabilitation was deliberately not rushed (seven sessions over a 12-week period, with an additional check-up at six months) to allow people with pain time to practice the new approach, and deal with flareups of their pain in a new manner.
“To maximise the impact of this new approach, we likely need to fundamentally alter how we train clinicians who treat people with pain, and how services are offered to people with pain,” explained Professor O’Sullivan.
“Unfortunately, right now, it is often easier for people with back pain to get access to ineffective treatments, even when they are more expensive, or risky, than good treatments,” he added.
The full paper, ‘Cognitive Functional Therapy with or without movement sensor biofeedback versus usual care for chronic, disabling low back pain (RESTORE): a randomised controlled, three-arm parallel group, phase 3, superiority clinical trial’, has just been published in The Lancet.
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)00441-5/fulltext