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, clinical trial
Background: Low back pain is the leading cause of years lived with disability globally, but most interventions have only short-lasting, small to moderate effects. Cognitive functional therapy (CFT) is an individualised approach that targets unhelpful pain-related cognitions, emotions, and behaviours...
| Main Authors: | , , , , , , , , , , , , , , |
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| Format: | Journal Article |
| Language: | English |
| Published: |
2023
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| Subjects: | |
| Online Access: | http://hdl.handle.net/20.500.11937/93042 |
| _version_ | 1848765689607749632 |
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| author | Kent, Peter Haines, T. O'Sullivan, Peter Smith, Anne Campbell, Amity Schutze, Rob Attwell, S. Caneiro, JP Laird, R. O'Sullivan, K. McGregor, A. Hartvigsen, J. Lee, D.C.A. Vickery, A. Hancock, M. |
| author_facet | Kent, Peter Haines, T. O'Sullivan, Peter Smith, Anne Campbell, Amity Schutze, Rob Attwell, S. Caneiro, JP Laird, R. O'Sullivan, K. McGregor, A. Hartvigsen, J. Lee, D.C.A. Vickery, A. Hancock, M. |
| author_sort | Kent, Peter |
| building | Curtin Institutional Repository |
| collection | Online Access |
| description | Background: Low back pain is the leading cause of years lived with disability globally, but most interventions have only short-lasting, small to moderate effects. Cognitive functional therapy (CFT) is an individualised approach that targets unhelpful pain-related cognitions, emotions, and behaviours that contribute to pain and disability. Movement sensor biofeedback might enhance treatment effects. We aimed to compare the effectiveness and economic efficiency of CFT, delivered with or without movement sensor biofeedback, with usual care for patients with chronic, disabling low back pain. Methods: RESTORE was a randomised, controlled, three-arm, parallel group, phase 3 trial, done in 20 primary care physiotherapy clinics in Australia. We recruited adults (aged ≥18 years) with low back pain lasting more than 3 months with at least moderate pain-related physical activity limitation. Exclusion criteria were serious spinal pathology (eg, fracture, infection, or cancer), any medical condition that prevented being physically active, being pregnant or having given birth within the previous 3 months, inadequate English literacy for the study's questionnaires and instructions, a skin allergy to hypoallergenic tape adhesives, surgery scheduled within 3 months, or an unwillingness to travel to trial sites. Participants were randomly assigned (1:1:1) via a centralised adaptive schedule to usual care, CFT only, or CFT plus biofeedback. The primary clinical outcome was activity limitation at 13 weeks, self-reported by participants using the 24-point Roland Morris Disability Questionnaire. The primary economic outcome was quality-adjusted life-years (QALYs). Participants in both interventions received up to seven treatment sessions over 12 weeks plus a booster session at 26 weeks. Physiotherapists and patients were not masked. This trial is registered with the Australian New Zealand Clinical Trials Registry, ACTRN12618001396213. Findings: Between Oct 23, 2018 and Aug 3, 2020, we assessed 1011 patients for eligibility. After excluding 519 (51·3%) ineligible patients, we randomly assigned 492 (48·7%) participants; 164 (33%) to CFT only, 163 (33%) to CFT plus biofeedback, and 165 (34%) to usual care. Both interventions were more effective than usual care (CFT only mean difference –4·6 [95% CI –5·9 to –3·4] and CFT plus biofeedback mean difference –4·6 [–5·8 to –3·3]) for activity limitation at 13 weeks (primary endpoint). Effect sizes were similar at 52 weeks. Both interventions were also more effective than usual care for QALYs, and much less costly in terms of societal costs (direct and indirect costs and productivity losses; –AU$5276 [–10 529 to –24) and –8211 (–12 923 to –3500). Interpretation: CFT can produce large and sustained improvements for people with chronic disabling low back pain at considerably lower societal cost than that of usual care. Funding: Australian National Health and Medical Research Council and Curtin University. |
| first_indexed | 2025-11-14T11:39:15Z |
| format | Journal Article |
| id | curtin-20.500.11937-93042 |
| institution | Curtin University Malaysia |
| institution_category | Local University |
| language | eng |
| last_indexed | 2025-11-14T11:39:15Z |
| publishDate | 2023 |
| recordtype | eprints |
| repository_type | Digital Repository |
| spelling | curtin-20.500.11937-930422023-09-19T02:47:33Z 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, clinical trial Kent, Peter Haines, T. O'Sullivan, Peter Smith, Anne Campbell, Amity Schutze, Rob Attwell, S. Caneiro, JP Laird, R. O'Sullivan, K. McGregor, A. Hartvigsen, J. Lee, D.C.A. Vickery, A. Hancock, M. Adult Humans Adolescent Low Back Pain Australia Biofeedback, Psychology Cost-Benefit Analysis Cognition Treatment Outcome RESTORE trial team Humans Low Back Pain Treatment Outcome Cognition Adolescent Adult Cost-Benefit Analysis Australia Biofeedback, Psychology Background: Low back pain is the leading cause of years lived with disability globally, but most interventions have only short-lasting, small to moderate effects. Cognitive functional therapy (CFT) is an individualised approach that targets unhelpful pain-related cognitions, emotions, and behaviours that contribute to pain and disability. Movement sensor biofeedback might enhance treatment effects. We aimed to compare the effectiveness and economic efficiency of CFT, delivered with or without movement sensor biofeedback, with usual care for patients with chronic, disabling low back pain. Methods: RESTORE was a randomised, controlled, three-arm, parallel group, phase 3 trial, done in 20 primary care physiotherapy clinics in Australia. We recruited adults (aged ≥18 years) with low back pain lasting more than 3 months with at least moderate pain-related physical activity limitation. Exclusion criteria were serious spinal pathology (eg, fracture, infection, or cancer), any medical condition that prevented being physically active, being pregnant or having given birth within the previous 3 months, inadequate English literacy for the study's questionnaires and instructions, a skin allergy to hypoallergenic tape adhesives, surgery scheduled within 3 months, or an unwillingness to travel to trial sites. Participants were randomly assigned (1:1:1) via a centralised adaptive schedule to usual care, CFT only, or CFT plus biofeedback. The primary clinical outcome was activity limitation at 13 weeks, self-reported by participants using the 24-point Roland Morris Disability Questionnaire. The primary economic outcome was quality-adjusted life-years (QALYs). Participants in both interventions received up to seven treatment sessions over 12 weeks plus a booster session at 26 weeks. Physiotherapists and patients were not masked. This trial is registered with the Australian New Zealand Clinical Trials Registry, ACTRN12618001396213. Findings: Between Oct 23, 2018 and Aug 3, 2020, we assessed 1011 patients for eligibility. After excluding 519 (51·3%) ineligible patients, we randomly assigned 492 (48·7%) participants; 164 (33%) to CFT only, 163 (33%) to CFT plus biofeedback, and 165 (34%) to usual care. Both interventions were more effective than usual care (CFT only mean difference –4·6 [95% CI –5·9 to –3·4] and CFT plus biofeedback mean difference –4·6 [–5·8 to –3·3]) for activity limitation at 13 weeks (primary endpoint). Effect sizes were similar at 52 weeks. Both interventions were also more effective than usual care for QALYs, and much less costly in terms of societal costs (direct and indirect costs and productivity losses; –AU$5276 [–10 529 to –24) and –8211 (–12 923 to –3500). Interpretation: CFT can produce large and sustained improvements for people with chronic disabling low back pain at considerably lower societal cost than that of usual care. Funding: Australian National Health and Medical Research Council and Curtin University. 2023 Journal Article http://hdl.handle.net/20.500.11937/93042 10.1016/S0140-6736(23)00441-5 eng http://creativecommons.org/licenses/by-nc-nd/4.0/ fulltext |
| spellingShingle | Adult Humans Adolescent Low Back Pain Australia Biofeedback, Psychology Cost-Benefit Analysis Cognition Treatment Outcome RESTORE trial team Humans Low Back Pain Treatment Outcome Cognition Adolescent Adult Cost-Benefit Analysis Australia Biofeedback, Psychology Kent, Peter Haines, T. O'Sullivan, Peter Smith, Anne Campbell, Amity Schutze, Rob Attwell, S. Caneiro, JP Laird, R. O'Sullivan, K. McGregor, A. Hartvigsen, J. Lee, D.C.A. Vickery, A. Hancock, M. 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, clinical trial |
| title | 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, clinical trial |
| title_full | 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, clinical trial |
| title_fullStr | 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, clinical trial |
| title_full_unstemmed | 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, clinical trial |
| title_short | 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, clinical trial |
| title_sort | 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, clinical trial |
| topic | Adult Humans Adolescent Low Back Pain Australia Biofeedback, Psychology Cost-Benefit Analysis Cognition Treatment Outcome RESTORE trial team Humans Low Back Pain Treatment Outcome Cognition Adolescent Adult Cost-Benefit Analysis Australia Biofeedback, Psychology |
| url | http://hdl.handle.net/20.500.11937/93042 |