The Origins of Cognitive Functional Therapy and the First RCT

Kjartan describes meeting Peter O'Sullivan in Australia in 1999 and attending his courses in Norway, drawn by his communication skills. Early work focused on how people move, using terms such as instability and core stability that were later seen in a different light. The approach evolved into a multidimensional framework that recognizes common patterns without putting people into boxes. The cognitive part addresses beliefs about pain, fear, anxiety, coping, sleep, stress and family history. The functional part looks at the valued activities people stop doing and how they move and think about moving. Therapy is not about putting joints back into place. In the trial, which began in 2006, 121 patients with persistent low back pain were randomized to cognitive functional therapy or manual therapy with exercise, delivered by experienced manual therapists, for 12 weeks. Both groups improved, but effect sizes for pain and disability in the cognitive functional therapy group were almost double, and results held at one year, with some at three years.