CFT+ With a Subsequent Interdisciplinary Pain Management Program (IPMP) If Needed Versus IPMP Alone for Patients With Severe Disabling Chronic LBP: Pragmatic Patient-Blinded RCT With Economic Analysis.

OBJECTIVES

We aimed to determine whether, for patients with severely disabling chronic low back pain (cLBP), initiating care with cognitive functional therapy combined with psychologist support (CFT+) improved disability and pain, and was cost-effective compared with an interdisciplinary pain management program (IPMP) at 12 months.

METHODS

We conducted a randomized controlled trial (NCT04399772) with concealed allocation, blinded patients, and intention-to-treat analysis. One hundred thirty-three adults with severely disabling cLBP, who were referred to an interdisciplinary pain center, were randomized to CFT+ for 3 months, with optional access to IPMP thereafter, or to IPMP alone. The primary outcome was the proportion of patients who achieved a ≥8-point improvement on the Oswestry Disability Index (ODI) at 12 months. Secondary outcomes were pain intensity, pain catastrophizing, patient enablement, global impression of change, and cost-effectiveness assessed using quality-adjusted life years (QALYs) derived from the EQ-5D-3L (EuroQol 5-Dimension 3-Level Questionnaire) and health care contacts.

RESULTS

At 12 months, ODI data were available for 46 (70%) patients in the CFT+ group and 45 (67%) in the IPMP group. A ≥8-point ODI improvement was achieved by 22% of patients who received CFT+ and 18% who received IPMP (difference, 3.9%; 95% CI: -12.4%, 20.3%; P = .64). Mean ODI change did not differ between groups (difference, 0.2; 95% CI: -3.8, 4.2; P = .92). There were no significant between-group differences for the secondary outcomes. Economic analysis estimated an incremental cost-effectiveness ratio of €53 075 per QALY for CFT+ versus IPMP.

CONCLUSION

CFT+ was not superior to IPMP for people with severely disabling cLBP. J Orthop Sports Phys Ther 2026;56(9):596-610. Epub 25 June 2026. doi:10.2519/jospt.2026.14238.