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Cognitive functional therapy (CFT)-based rehabilitation improves clinical outcomes in UK military personnel with persistent low back pain
  1. Dean Conway1,2,
  2. P Ladlow2,
  3. J Ferreira1,
  4. S Mani-Babu1 and
  5. A N Bennett2,3
  1. 1 Centre for Spinal Rehabilitation, Defence Medical Rehabilitation Centre (DMRC), Headley Court, Surrey, UK
  2. 2 Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre (DMRC), Headley Court, Surrey, UK
  3. 3 Faculty of Medicine, Imperial College London, National Heart and Lung Institute, London, UK
  1. Correspondence to P Ladlow, Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre (DMRC), Headley Court, Surrey KT18 6JW, UK; peter.ladlow100{at}


Introduction Low back pain (LBP) has been reported as the most common reason for presentation to the Medical Centre in the British Military, and the most common re-referral for the same condition. In 2015, the UK Defence Medical Rehabilitation Centre (DMRC) adopted a cognitive functional therapy (CFT) approach to spinal rehabilitation in line with National Institute for Health and Care Excellence and military best practice guidelines. The aim of this study is to evaluate the functional and psychosocial outcomes of all patients with chronic LBP treated with CFT-based multidisciplinary rehabilitation at DMRC, Headley Court.

Methods A prospective observational service evaluation of British Military patients (n=238) with LBP who attended 3 weeks of inpatient multidisciplinary CFT-based programme from 2015 to the end of 2017 at DMRC was analysed. Functional outcomes include: multistage locomotion test (MSLT) and sit and reach test. Psychosocial outcomes include: Tampa Scale of Kinesiophobia, Oswestry Disability Index, Brief Pain Inventory (BPI), General Anxiety Disorder-7 and Patient Health Questionnaire-9.

Results There were significant improvements in endurance (MSLT), range of motion, kinesiophobia, pain-related lifestyle interference (BPI-Lifestyle), anxiety and depression (p≤0.001). However, no improvements in pain intensity (BPI-Intensity) were demonstrated (p>0.05).

Conclusion After 3 weeks of CFT-based multidisciplinary rehabilitation, function and psychosocial health improved with symptoms of pain being less obtrusive to activities of daily activity. There were however no patient-reported reductions in pain intensity. The improvements demonstrated are indicative of outcomes that facilitate greater integration back to work or into society.

  • cognitive functional therapy
  • low back pain
  • function
  • psychosocial
  • clinical outcomes
  • military

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  • Contributors JF and PL conceived the study design. JF managed data collection. DC performed the data analysis. All authors analysed and interpreted the findings. DC wrote the draft manuscript. All authors read, critically reviewed and approved the final version.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Data are openly available, but due to privacy concerns, some data regarding participants are available only to bona fide researchers working on a related project, subject to the completion of a non-disclosure agreement. Access requests for any restricted data should be sent to