An investigation of the relationship between movement, pain, and function in 12 individuals with persistent, disabling low back pain.

Cognitive Functional Therapy (CFT): All participants receive CFT. CFT is best briefly described as an integrated, personalised, behavioural approach to the identification and management of modifiable multidimensional factors underlying a person’s pain and activity limitation. It has foundations in behavioural psychology and neuroscience within physiotherapy practice. CFT comprehensively operationalises and integrates a self-management program, targeting psychological (cognitive and emotional factors), physical (e.g. movement and avoidance) and lifestyle factors (e.g. sleep and stress). The intervention is provided by specially trained physiotherapists with at least 100 hours of experience in this approach. It will be delivered face-to-face in a clinical setting and will address these targets using a tailored behavioural self-management plan depending on which factors are dominant for each individual. The CFT intervention treatment components consist of: (1) Cognitive: Education focused on the reconceptualization of pain within a biopsychosocial context related to the person’s story and valued daily life goals. Negative pain beliefs related to radiological imaging are specifically addressed in this process if appropriate and the role of an unhealthy lifestyle on pain and activity limitation are explained. (2) Functional training: Pain controllability is enhanced through normalization of postures and movements, discouraging pain behaviours, while safely performing feared and/or painful movements and activities in a graduated manner. These newly learned movement behaviours are then incorporated into daily tasks with respect to levels of pain control. The movements and behaviours targeted will be tailored to the specific task the individual with back pain nominates they have most limitations with (based on their answers in the Patient Specific Functional Scale which will be corroborated during the first assessment session). Examples of common movements or behaviours include bending, sitting, lifting, standing and walking. (3) Lifestyle training: Addressing physical activity levels, ensuring its performance is in a relaxed, confident, and mindful manner while developing skills to enhance stress coping and sleep hygiene. The treatment dosage for all participants is up to 10 sessions in total over the 12-week intervention. The initial session is 1hr with follow-ups of 30–45 min. Participants are seen weekly for 2-3 sessions and progressed to one session every 2–3 weeks based on clinical course. Participants are requested to practice the strategies at home (the patient is encouraged to practice the strategies whenever they perform the movement/postural task throughout the day, this is usually on a daily basis however does depend on the patient) and to become increasingly aware of both physical and psychosocial dimensions to their pain, both during and after the intervention period. Adherence to the at-home practice will not formally be monitored. A 5-week baseline control phase includes the collection of movement, pain, activity limitation and psychological factor data on five occasions (weekly). No intervention will be provided during this phase.