Low back pain is the leading cause of disability, affecting over 620 million people globally.

While most people who have an episode of low back pain recover quickly, up to 30 per cent experience long-term pain lasting three months or more.

Physiotherapists play a key role in treating people with chronic low back pain but there is uncertainty regarding which physiotherapy interventions are most effective.

Cognitive functional therapy (CFT) is a patient-centred approach in which personalised coaching sessions help patients self-manage their pain by targeting cognitions, emotions and behaviours related to their pain and disability.

The RESTORE trial, published in The Lancet in 2023 (here), found that the use of CFT produced large and clinically significant effects in reducing disability when compared to usual care, which were sustained for one year.

CFT was also found to be cost saving, with noteworthy reductions in work absenteeism and productivity losses.

The research team has now received funding from the Medical Research Future Fund to progress this work, further exploring the implementation of CFT across private, public and rural physiotherapy settings.

Aims

The primary aim of our new study is to assess and compare the clinical and cost- effectiveness of physiotherapist-delivered CFT against usual physiotherapy practice to reduce disability for people seeking care for chronic disabling low back pain.

The secondary aim is to assess the implementation of CFT, including the feasibility of delivering CFT in various clinical settings as well as the scalability and effectiveness of the clinician training program to upskill clinicians to deliver high- quality biopsychosocial care (CFT).

These aims will be assessed in rural and remote communities in addition to metropolitan areas, across public and private services, to encourage accessibility across Australia.

Methods

This study is a cluster, randomised controlled trial conducted in routine physiotherapy settings for patients with chronic, disabling low back pain.

We will randomise 24 physiotherapy clinics (in private practice and public hospital settings, across rural and metropolitan areas) to either continue delivering their usual care or undergo training in delivering CFT.

We will recruit 720 people (360 per group) who are presenting to physiotherapists with chronic, disabling low back pain.

Clinicians randomised to deliver CFT will undergo a combination of online and face- to-face training.

Rural clinicians will receive all the training via online formats.

At the end of the trial, clinicians in the control group will be given access to online learning.

We will also collect data and feedback from the clinicians we train to assess whether the training was acceptable and whether it improved their confidence and competence in caring for people with complex chronic low back pain.

Future impact

The results from this study will add to the existing evidence on CFT—specifically, whether it improves outcomes compared to usual physiotherapy care.

If it is found to be effective, this would provide strong evidence for scaling up training and access.

The study will also assist in developing training methods and resources to maximise the accessibility of CFT training to physiotherapists across Australia.

How to participate

You may be eligible to take part if you: 

• are an Ahpra-registered physiotherapist 
• currently work in either private practice or a public hospital setting in Perth, Sydney or any regional or rural location in Australia 
• treat patients with chronic low back pain on a regular basis.

For more information, head to the study website (here).