Is CFT THE Answer? Peter O’Sullivan and Peter Kent discuss the RESTORE trial

A recent trial published in The Lancet ^[1] could have big implications for practice. Terms like ‘biopsychosocial approach’ are bandied around and most of us believe we integrate that model into our own practice – but the reality is very different. The RESTORE trial highlights key issues in current treatment for chronic lower back pain, and proposes a solution. You can listen to the full podcast here. ^[2]

The trial addresses big gaps in both patient care and in training for physiotherapists.

These gaps resulted in many clinicians lacking the confidence and skills to tackle one of the most common ailments of our time. The good news? This promising research has the potential to reshape our understanding, and treatment, of chronic lower back pain. 

Jack Chew sat down with Peter O’Sullivan and Peter Kent – both professors at Curtin University, and two of the brains behind the RESTORE trial. As they requested in the podcast, they will be referred to, respectively, as Peter and PK throughout.

In this conversation, Peter stated that many physios feel addressing psychosocial factors falls outside their scope of practice. These factors are so important, but they’re often a key part of Physiotherapy training that is skimmed over. He believes that most physios don’t align their care to the guidelines, but that’s not the fault of individual clinicians. “We’ve not skilled our workforce to deliver care aligned to the guidelines.” Cognitive Functional Therapy (CFT) is a potential solution to that gap in training.

What is CFT? There are three key pillars to CFT:

1. Making sense of pain 

2. Exposure with control

3. Lifestyle change. 

Peter described how CFT takes the patient’s story, understanding and beliefs about what’s going on with their back, and explores that in depth. So many patients with chronic, disabling back pain are told that their back is damaged, that the MRI results look terrible or that they should move cautiously to keep their back safe. They become trapped in a cycle of pain, inactivity and fear. The goal of CFT is to break that cycle and provide a strong foundation for patients to return to the things they love, with the tools to self-manage relapses in the future.