OBJECTIVE: Our aim was to investigate whether cognitive functional therapy (CFT) was more effective than core exercises and manual therapy in improving pain and function for patients with chronic low back pain after spinal surgery. METHODS: This study was a randomized controlled superiority trial in a university hospital and a private physical therapy clinic in Santa Catarina, Brazil. Eighty participants who were 18 to 75 years old and had chronic low back pain after spinal surgery received 4 to 12 treatment sessions of CFT or core exercises and manual therapy once per week for a maximum period of 12 weeks. Primary outcomes were pain intensity (numeric pain rating scale, scored from 0 to 10) and function (Patient-Specific Functional Scale, scored from 0 to 10) after intervention. RESULTS: We obtained primary outcome data for 75 participants (93.7%). CFT was more effective, with a large effect size, than core exercises and manual therapy in reducing pain intensity (mean difference (MD) 2.42; 95% CI 1.69 to 3.14; effect size (d) 0.85) and improving function (MD -2.47; 95% CI -3.08 to -1.87; effect size 0.95) after intervention (mean 10.4 weeks (SD 2.17) after the beginning of treatment). The differences were maintained at 22 weeks for pain intensity (MD 1.64; 95% CI 0.98 to 2.3; effect size 0.68) and function (MD -2.01; 95% CI -2.6 to -1.41; effect size 0.81). CONCLUSION: CFT was more effective than core exercises and manual therapy, with large effect sizes, and may be an option for patients with chronic low back pain after spinal surgery.

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