Cognitive Muscular Therapy Versus Psychologically Informed Physiotherapy for Low Back Pain: A Feasibility Trial

Conflict of interest: No conflicts of interest Source of funding: This study was funded by the UK National Institute for Health and Care Research (NIHR), Research for Patient Benefit programme, NIHR206212 Purpose Cognitive Muscular Therapy (CMT) is a new treatment for low back pain (LBP) which integrates psychological techniques for pain management alongside training to improve postural control. A key therapeutic aim of CMT is to reduce overactivity of abdominal, neck shoulder and paraspinal muscles and reduce mechanical loading on the spine. This feasibility study was performed to inform planning of a future RCT designed to compare CMT with best practice psychologically informed physiotherapy (PIP) for chronic LBP. We sought to understand the feasibility of training physiotherapists and to estimate recruitment, adherence, retention and the potential signal of effectiveness. Methods Participants classified as high/medium risk of poor long-term outcome (STarT Back tool) were recruited from GPs, physiotherapy departments and social media. Four NHS physiotherapists delivered the CMT intervention. Results 78 participants were randomised over a 9-month period, with 30 (of 38 allocated to CMT intervention) and 26 (of 40 allocated to the PIP intervention) meeting conditions for adherence (missing <2 intervention sessions). Outcome data is available for 53 participants. Between baseline and 14-week follow-up, disability (Roland-Morris score) reduced by 51% in the CMT arm (mean (SD) 13.2 (4.2) to 6.4 (6.4), n=29), and 23% in the PIP arm (14.3 (5.1) to 11.0 (6.5), n=24). Conclusion A full trial comparing CMT to best practice PIP appears feasible and the results show a clear signal of effectiveness. If the magnitude of this change is replicated in a larger trial, CMT could drive a change in the physiotherapy management of LBP.