Breaking the cycle of persistent low back pain, health inequalities and multimorbidity: a UK NHS cohort study of Cognitive Functional Therapy

Introduction: Low back pain (LBP) disproportionately affects socioeconomically disadvantaged individuals, ethnic communities, and those with multimorbidity. Cognitive Functional Therapy (CFT) is a physiotherapist-led intervention targeting the biopsychosocial complexity of LBP, not previously evaluated in people affected by health inequalities. This study aimed to determine the clinical and cost benefits of CFT in people with LBP living in the most deprived areas of a multi-ethnic UK city.
Method: Single cohort study.
Participants: Adults aged >18 years with LBP (>3 months), reduced work ability due to LBP, living in the 20% most deprived areas of Coventry, and having 2 or more long-term conditions.
Intervention: Cognitive Functional Therapy.
Healthcare resource use data were collected for 13 weeks pre-intervention, and at 13 and 26 weeks. Measures of self-reported pain intensity and disability were collected at baseline, 13, and 26 weeks. Descriptive analysis identified changes in self-reported outcomes. Cost-benefit analysis used NHS tariffs.
Results: 61 participants (64% female, mean age 51 years, LBP duration 6.8 years, 4.6 comorbidities). Baseline disability (RMDQ) was 17.2 and pain intensity 7.6. At 26 weeks, mean disability reduced to 11.7 (mean reduction 5.5, 95% CI 3-8) and pain to 4.4 (mean reduction 2, 95% CI 1.1-2.9). Healthcare contacts for LBP reduced from 2.1 to 0.3 at 26 weeks. Opioid prescriptions reduced by 32%, saving £25.20 per participant. 5.3 CFT appointments were attended at a cost of £334 per participant.
Conclusion: Pain, disability, and healthcare utilisation costs reduced following CFT for people with persistent LBP living in deprived areas with multimorbidity.