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Article Appraisal Summary: Qualitative

Article Title: Patient Perspectives on Participation in Cognitive Functional Therapy for Chronic Low Back Pain.

Author(s): Samantha Bunzli, Sarah McEvoy, Wim Dankaerts, Peter O’Sullivan, Kieran O’Sullivan

Journal, Year, Volume/Issue, Pages: Physical Therapy, 2016, 96(9), 1397-1407

PICO Question: In a 50 y/o male with chronic low back pain lasting the last 9 months, does Cognitive Functional Therapy
(CFT) reduce functional disability as measured by the Oswestry Disability Index?

Study Clinical Chronic low back pain (CLBP) is a very common diagnosis that causes distress and
Problem/Background disabilities. Many factors including biological, psychosocial, behavioral and lifestyle factors
play a role in CLBP.
Objective(s) Investigate the patients’ experiences with CFT in order to yield information about the
implementation of this intervention.

Qualitative Design Non-Interventional Cross-Sectional Qualitative Design

Subjects Australian/Irish Adults with CLBP

Sample Size 14

Inclusion criteria Participated in a CFT intervention, CLBP, Oswestry Disability Outcomes

Exclusion criteria None listed. Purposive sampling was employed.

Subject selection Ireland and Australia

Data Collection One-on-one interviews were conducted. Semi-structured questions were asked including
(circumstance of CLBP, CLBP impact on life, and prior interventions). Follow up questions
were asked in regard to CFT.
Data Analysis Coding was performed by two authors and a process of constant comparative analysis was
employed. Participants were split into groups (large/small improvers and no change).

Major Themes Changing Pain Beliefs, Achieving Independence

Results/Interpretation Changing beliefs: therapeutic alliance, body awareness and pain control
Independence: problem solving/high self-efficacy, fear, stress coping and normality

Study Author’s Conclusions: Do not copy-paste. Create a summary of the authors’ conclusions
The success of CFT is highly dependent on the patient’s ability to adopt the biopsychosocial approach and to self-
manage their pain.

Your interpretation: What conclusions did you draw from the results and conclusions?
CFT is a useful treatment when looking at the changes in Oswestry Disability Index scores from pre and post
intervention. The themes identified in this study contribute much to the understanding of the mechanisms underlying
the improvements. A common theme amongst CFT is the ability of the patient to understand that the pain they are
feeling is not from damage, but rather, their system in another form. It is important to address independence and buy-in
to the biopsychosocial model if you want to see the most impact from CFT therapy.

Study Quality: Describe factors about the study as a whole that would increase or decrease its quality, how confident you
are in their results and how well those results would apply to the general population of interest.
Overall, the study was well conducted as was performed until no more themes were generated. However, the
participants included may not be wholly representative of the population in general. The study was of high quality and
addressed many limitations as well as providing insights for clinicians.

Applicability to PICO Question: How does the information in the study specifically apply to your PICO question? How can
you make a connection between the study results and the question you are trying to answer?
The article relates to my population, intervention and outcome. This makes this article a useful tool in treatment of the
patient.