Cognitive Functional Therapy for Chronic Low Back Pain: A Systematic Review and Meta-Analysis.

All trials required substantial clinician training (over 80 hours with mentoring), so it is unclear how well CFT works when delivered by less-experienced clinicians or in settings without that level of support. The trial with the smallest effects was delivered by a single recently graduated therapist without a formal competency assessment, and the authors note this limits generalizability. No gray literature was searched, so completed but unpublished trials cannot be excluded, leaving potential publication bias. One author has a leading role in the development, teaching, and research of CFT, and two others have been involved in prior CFT research, which the authors acknowledge as a potential source of bias. The long-term pain confidence interval spans values that some patients would consider worthwhile and others would not, so the clinical meaning of the effect is uncertain.

One author (P.O.) has played a leading role in the development, teaching, and research of CFT, and two other authors (P.K. and M.J.H.) have been involved in previous CFT research. The authors state this could represent a potential source of bias. No external funder or industry sponsor is named in the provided text.

Do not read this as proof that CFT reliably reduces pain at 12 months. The long-term pain result was not clearly different from the comparison group (95% CI from −0.2 to 15.8), and the trial with the smallest effects was delivered by a single newly graduated therapist without a competency check. The benefit depends on a level of training and supervision that most clinics may not be able to replicate.