Effects of Cognitive Functional Therapy Versus Kinetic Control Training on Pain, Disability, Movement Control in Patients With Non-specific Low Back Pain

Low back pain (LBP) has the highest prevalence globally among musculoskeletal disorders, affecting around 619 million people in 2020 and it is expected that the number of cases will increase to 843 million by 2050. LBP is defined as the localized pain below the costal margin and above the inferior gluteal folds which may or may not include leg pain. It is commonly categorized as specific and non-specific low back pain. Non-Specific Low Back Pain (NSLBP) accounts for nearly 90% of all cases.

NSLBP is multifactorial and mostly new cases recover within a short time but the condition frequently recurs and may become persistent. An extensive review regarding the management of LBP has stated that exercise plays a fundamental role in treating patients with NSLBP. However, the results regarding the appropriate type of exercise are the subject of controversy. Over the past decades, researchers have advised a variety of exercises. However, despite applying various treatment approaches, conservative treatment for NSLBP yields small effect sizes.

Cognitive Functional Therapy (CFT) is a contemporary exercise intervention developed by Peter O'Sullivan, to address the multidimensional nature of non-specific low back pain. The CFT is structured into three phases: (1) making sense of pain, (2) exposure with control, and (3) lifestyle changes. Rather than adopting a one size fits all approach, CFT provides clinicians with the opportunity to explore the multidimensional nature of NSLBP.

Kinetic Control Training (KCT) developed by Comerford, is a clinical framework focused on the assessment and correction of uncontrolled movement. KCT emphasizes identifying direction-specific movement faults (e.g., flexion, extension, rotation control deficits) that contribute to symptom provocation. KCT utilizes a three-stage retraining process: (1) cognitive facilitation of correct muscle activation; (2) integration into low-load, non-provocative tasks; and (3) progression to complex, functional movements under load and fatigue.

Despite the promising evidence supporting both CFT and KCT, a clear comparative study of their effectiveness in addressing NSLBP is lacking. Most existing studies have focused on one technique or compared it with general exercise. This study seeks to address this gap by evaluating and comparing the effects of Cognitive Functional Therapy and Kinetic Control Training in individuals with NSLBP.