Comparing the Effectiveness of Cognitive Functional Treatment and Lumbar Stabilization Treatment on Pain and Movement Control in Patients With Low Back Pain

Abstract

Background: The treatment of chronic low back pain (LBP) should target both behavioral variables and physical performance factors. Hypothesis: Cognitive functional treatment (CFT) and lumbar stabilization treatment (LST) will result in positive changes in pain and lumbar movement control (LMC) in patients with LBP. Study Design: Pretest-posttest intervention. Level of Evidence: Level 3. Methods: After screening, 52 participants (mean age, 44.3 ± 2.46 years) with chronic LBP were allocated into CFT (n = 17), LST (n = 17), or control (n = 18) groups. Pain and LMC were evaluated before and after 8 weeks of intervention with visual analog scale (VAS) and Luomajoki LMC battery tests, respectively. Results: Compared with baseline, pain and LMC were reduced and improved significantly in both groups after 8 weeks. However, the changes in both variables were not significantly different between groups. Percent change for pain between pretest and posttest values in the LST group was a decrease of 45% ( P = 0.003), compared with a decrease of 40% ( P = 0.003) in the CFT group. Change in LMC in the LST group was a decrease of 100% ( P = 0.026), compared with a decrease of 200% ( P = 0.018) in the CFT group. There as no change for both variables in the control group. Conclusion: Both CFT and LST groups improved LMC scores and reduced pain intensity. However, there was no difference between the 2 experimental groups on pain and LMC test results. Clinical Relevance: In this study, intended to construct an intervention for people with chronic LBP, the primary aims were to help individuals “make sense of their pain,” develop effective pain control strategies via body relaxation and extinction of safety behaviors, and adopt healthy lifestyle behaviors to affect cognitive factors known to affect pain sensitivity and disability. These primary aims were achieved through an emphasis on factors such as development of positive beliefs, reduced fear, increased awareness, enhanced understanding and control of pain, adaptive coping, enhanced self-efficacy, confidence, and improved mood through the class-based intervention.