Papers of the Week

To evaluate whether cognitive functional therapy (CFT) is an effective treatment for adults with chronic low back pain (LBP) Intervention systematic review with meta-analysis. CENTRAL, CINAHL, MEDLINE, Embase, clinicaltrials.gov, EU clinical trials register (to March 2022). Randomised controlled trials evaluating CFT for adults with LBP. The primary outcomes were pain intensity and disability. Secondary outcomes were psychological status, patient satisfaction, global improvement, and adverse events. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool. Certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation approach. Random-effects meta-analysis with the Hartung-Knapp-Sidik-Jonkman adjustment was used to estimate pooled effects. Fifteen trials were included (nine ongoing, one terminated), of which five provided data (n=507; n=262 CFT and n=245 control). There was very low certainty for the effectiveness of CFT compared to manual therapy plus core exercises (two studies, n=265) for reducing pain intensity (mean difference -1.02/10, 95% CI -14.75 to 12.70) and disability (mean difference -6.95/100, 95% CI -58.58 to 44.68). Narrative synthesis showed mixed results for pain intensity, disability, and secondary outcomes. No adverse events were reported. All studies were judged to be at high risk of bias. CFT may not be more effective than other common interventions for reducing pain and disability in adults with chronic LBP. The effectiveness of CFT is very uncertain and will remain so until higher quality studies are available.