For the past six years a team of researchers has been investigating the clinical and economic effectiveness of using cognitive functional therapy (CFT) for the treatment of chronic low back pain.

Their study is called RESTORE and initial findings from the research program report significant and sustained reductions in disability, pain and other outcomes, as published in The Lancet in June last year.

Professor Mark Hancock APAM, director of research in the Department of Health Sciences at Macquarie University, is one of the researchers.

Mark says the team has continued to explore the initial results as well as undertake further trials.

‘Low back pain is a leading cause of disability, affecting almost everyone at some point in their life.

‘It results in emotional, physical, societal, economic and health system impacts.

‘The disability burden caused by low back pain is projected to increase in coming decades.’

Mark will share new insights from the ongoing study at the 2024 ACT Forum in November and will discuss what the shift to a biopsychosocial approach when managing chronic musculoskeletal pain means for the future of physiotherapy practice.

‘This research is ongoing and new; we have yet to release the latest findings, so attendees will be the first to hear how these positive findings can be applied in real-world clinical practice,’ says Mark, whose research focuses on the diagnosis, prevention and treatment of low back pain.

He has published more than 240 peer-reviewed papers in leading journals, including The New England Journal of Medicine, The Lancet, The British Medical Journal and Journal of Physiotherapy.

His keynote is called ‘RESTORE study: what does it mean for physiotherapists and what next?’.

RESTORE was a large-scale clinical trial in which physiotherapists underwent extensive training to deliver a highly individualised, patient-centred intervention, addressing the range of factors contributing to ongoing pain and disability.

‘The core elements of the CFT approach include helping patients develop a better understanding of their pain, empowering them to take an active role in managing their condition and tailoring the treatment plan to each patient’s unique needs, goals and barriers to recovery,’ explains Mark.

Patients who received the CFT intervention showed significantly greater improvements in pain, disability and quality of life compared with those who received usual care.

‘Importantly, our recent unpublished analyses show that these benefits were sustained over a three-year follow-up period, highlighting the long-term impact of the CFT approach,’ says Mark.

‘What’s really exciting about the RESTORE study is that it’s not just about short- term outcomes.

‘We’ve seen these positive effects persist for years, which is a testament to the power of this approach to truly transform the lives of patients with chronic pain.’

New findings that will be presented include the three-year follow-up results, a moderation analysis to identify the patients who respond best to CFT intervention and mediation analyses to explain how the treatment is working.

‘These results are critical to understanding the effectiveness within this study—what we have to change to produce the positive effects.

‘We’ve even looked at whether the intervention had an effect on opioids, which is a different outcome.’

The CFT approach emphasises tailoring the treatment plan to each individual patient, which aligns with the physiotherapy profession’s recognition of the value of individualised, rather than standardised, care.

Professor Mark Hancock will talk about his recent RESTORE and WalkBack trial results at the ACT Forum.

‘The RESTORE study really underscored the importance of considering each patient’s unique needs, goals and barriers and adapting the intervention accordingly,’ says Mark.

‘This requires physiotherapists to develop the skills to conduct thorough assessments, identify the key biopsychosocial factors at play and collaboratively develop a treatment plan that addresses the patient’s specific needs.’

A key takeaway from the study is the shift in the physiotherapist’s role from ‘treater’ to ‘coach’.

Rather than focusing on passive or hands-on treatment, the CFT approach encourages physiotherapists to take a more collaborative, empowering role with their patients.

‘The goal is to help patients develop the knowledge, skills and confidence to effectively self-manage their condition, with the physiotherapist serving as a guide and support system,’ Mark says.

‘This requires physiotherapists to hone their communication and health coaching skills, delivering effective pain education, validating the patient’s experience and motivating behaviour change.’

This shift in mindset can be challenging for some physiotherapists, who may be accustomed to a more traditional approach.

Mark believes, however, that embracing this coaching role is essential for providing truly holistic, person-centred care.

‘We know that chronic pain is a complex, multifaceted condition influenced by a range of biological, psychological and social factors.

‘By taking on the role of coach, physiotherapists can help patients navigate this complexity and empower them to take an active role in their own recovery.’

Mark will also discuss results from the team’s WalkBack trial, which was published in The Lancet earlier this year.

The study investigated a progressive and individualised walking and education program for the prevention of recurrences of low back pain.

‘The study showed significant reductions in the risk of recurrence and associated care seeking,’ Mark says.

‘The results of this study are very exciting because we now have an effective, accessible, safe intervention that can reduce recurrences of back pain.

‘For a long time, we have largely ignored prevention of back pain and focused on treating episodes.

‘This needs to change and these results help with that shift in focus.’

Next steps for the researchers include expanding access to CFT and working to further improve outcomes.

With funding from the Medical Research Future Fund, they’ll test the training and implementation of CFT in both public and private care settings in metropolitan and rural areas.

‘I am really excited about this next study.

‘We will test new ways of training physiotherapists to make the training and intervention far more accessible.

‘This study will directly compare patient outcomes between physiotherapists who have undergone CFT training and those who have not.’

>> The 2024 ACT Forum will be held on Wednesday 13 November, 6.30–9.30 pm, in Barton, Australian Capital Territory. Click here
 for more information and to book.