Our study aimed to rate the replicability of the CFT and control group interventions in the trials included in the Zhang et al. systematic review and elucidate how CFT procedures are differentiated from those of CBT.
Two reviewers independently extracted data from 21 documents that included the eight trials’ published articles, protocols, appendices and supplementary files into Microsoft Excel using the Template for Intervention Description and Replication (TIDieR) checklist (Hoffman, et al, 2014). This checklist has 12 items to describe the ‘why’, ‘what materials and procedures’, ‘who’, ‘how’, ‘where’, ‘when and how much’, ‘tailoring’, ‘modifications’, ‘planned adherence’ and ‘actual adherence’ for each intervention. We rated the descriptions and replicability of the CFT interventions and control groups as ‘sufficiently reported’, ‘partially reported’ and ‘not reported’, resolving discrepancies by consensus.
No trials reported 100% of the TIDieR items; the mean ‘sufficiently reported’ rating was 54% (range 33-67%) for the CFT interventions and 35% (range 8-67%) for controls. The six most replicable items were the same for CFT and control groups. These were ‘brief name’ (CFT=100%; control=100%), ‘why’ (CFT=100%; control=50%), ‘how’ (CFT=100%; control=50%), ‘what procedures’ (CFT=88%; control=63%), ‘where’ (CFT=88%; control=75%) and ‘planned adherence’ (CFT=75%; control=38%). Items reported insufficiently for either CFT or control groups included ‘when and how much’, ‘tailoring’ and ‘actual adherence’. The differentiation between CFT procedures and the established CBT ones was unclear.
The descriptions of the CFT and control group interventions in the eight trials were insufficient to ensure replication. Incomplete descriptions hinder clinicians from accurately applying the treatment intervention to patients and thwart researchers from replicating the interventions and controls in studies. Future work is required to elucidate the distinction between CFT and CBT procedures and robust three-armed randomised controlled trials are necessary to compare the efficacy of CFT versus CBT in managing CLBP.
Our study exemplifies the critical need for future CFT researchers to follow the TIDieR checklist when designing and reporting the descriptions of their interventions. This will enable replicability and reduce research waste. Physiotherapy practitioners and educators interested in CFT need to weigh it against CBT and ensure that they follow accurately the research authors’ intervention descriptions from high-quality trials to maximise treatment fidelity and efficacy.
Cognitive Behavioural Therapy
Back pain
