Relationships Between Changes in Forward Bending, Pain Catastrophising and Pain Self-Efficacy During Cognitive Functional Therapy for People With Chronic Low Back Pain

OBJECTIVES: To investigate whether improvements in forward bending were related to reductions in pain catastrophising (PC) and improvements in pain self-efficacy (PSE) in people with chronic low back pain (CLBP) who were undergoing Cognitive Functional Therapy (CFT). DESIGN: Longitudinal observational study. METHODS: Two hundred and sixty-one participants with CLBP received CFT. Forward bending was assessed at each treatment session over 13-weeks (average of 4.3 timepoints/participant [range 1–8]). Inertial measurement units placed on T12 and S2 measured spinal ROM and velocity. Participants completed the Pain Catastrophising Scale and Pain Self-Efficacy Questionnaire online at 0, 3, 6, and 13 weeks. Multivariate multilevel models evaluated associations between individual rates of change over time for three spinal movement measures (trunk velocity, trunk ROM, lumbar ROM) and PC/PSE. RESULTS: Strong correlations were observed for increased trunk velocity with reduced PC ( r=−0.56, 95% CI: −0.82, −0.01) and increased PSE ( r=0.63, 95% CI: 0.18, 0.87). There was no evidence of an association between changes in trunk ROM and PC ( r=−0.06, 95% CI: 0.38, 0.28) or PSE ( r=0.36, 95% CI: −0.27, 0.65), and no evidence of an association between lumbar ROM and PC ( r=-0.07, 95% CI: −0.63, 0.55) or PSE ( r=0.16, 95% CI: −0.49, 0.69). CONCLUSION: Improvements in PC and PSE were strongly correlated with increased trunk velocity—but not trunk or lumbar ROM—in people with CLBP who were undergoing CFT. These findings are consistent with CFT that explicitly trains ‘non-protective’ spinal movement in conjunction with positively reframing pain cognitions.