Trial Report Cognitive Behavioural Therapy to Optimize Post-Operative Fracture Recovery (COPE): a randomized controlled trial, 2026, Busse+

[rvallee]

Cognitive Behavioural Therapy to Optimize Post-Operative Fracture Recovery (COPE): a randomized controlled trial | CMAJ

Abstract​

Background: Persistent pain after extremity fracture requiring surgical repair is common and associated with long-term morbidity. We sought to determine whether app-based cognitive behavioural therapy (CBT) reduces persistent postsurgical pain after fracture repair.

Methods: We performed a randomized controlled trial of adults from 11 American and Canadian hospitals with an extremity fracture treated with internal fixation. We allocated participants 1:1 to an app-based CBT program or usual care, and followed them at 3, 6, 9, and 12 months post-fracture. Our primary outcome was moderate-to-severe persistent post-surgical pain. We constructed a mixed-effects log-binomial model to explore the effect of CBT versus usual care on moderate-to-severe persistent post-surgical pain over 12 months postfracture.

Results: We randomized 1009 participants to app-based CBT (n = 506) or usual care (n = 503). The mean age of participants was 44.5 years, and 129 (12.8%) presented with an open fracture. Adherence to CBT was modest, with 237/506 patients (46.8%) completing all 7 modules. App-based CBT, compared with usual care, did not reduce the risk of persistent postsurgical pain over 12 months postfracture (30.8% v. 30.3%, adjusted relative risk 1.02, 95% confidence interval [CI] 0.89 to 1.16). The 365-day probability of returning to leisure activities without restrictions was 29.0% in the intervention group and 22.4% in the control group (hazard ratio 1.33, 95% CI 1.00 to 1.77). The other secondary outcomes showed no significant differences between treatments.

Interpretation: Among adults with an operatively managed extremity fracture, app-based CBT did not reduce the risk of persistent postsurgical pain over 12 months. Future research is warranted to develop more effective CBT approaches for adults with extremity fractures and to evaluate alternative supportive interventions that may be more acceptable to patients with fracture.

 

[rvallee]

6+ years, 11 hospitals, 1K+ participant, two dozen academics, likely millions in funding, all to get the equivalent of 42 as an answer. What an incredible waste. The conclusion is insane, why would there be such efforts? What form could they possibly even take? It's literally always the same thing! There has been no research on CBT in decades, all they do is spam a button to try again.

The ideology can never fail, it can only be failed. It will be failed, again and again. And again and forevermore.

 

[rvallee]

Nor did CBT improve physical or mental functioning

It didn't even achieve the thing it's mainly for. This is literally the only claim they make that makes the tiniest bit of sense, that isn't absurd in its premise, and it doesn't even achieve that.

Our primary limitation was modest participant adherence with the completion of CBT modules.

It's an active participating thing, failing at participation is like having a pill that half of patients can't even swallow because it's too big. It always fails at this when they don't pre-select, half participation is typical. They seem to clutch to the idea that if they could just boost participation, then they'd have something. What a complete and total waste of everything. This is by far the least useful sub-part of the entire academic world.

 

[SNT Gatchaman]

The trial was also limited by differential rates of consent withdrawal between treatment groups, with a higher proportion of participants randomized to the CBT group withdrawing consent. This may reflect challenges associated with participating in the CBT program.

Where "challenges associated with participating in the CBT program" equate to "the participants recognised its validity and responded accordingly".

The program consisted of 7 self-directed learning modules, each requiring approximately 1 hour to complete, focused on addressing maladaptive beliefs related to pain and recovery, as well as practical strategies to enhance coping and management of pain.

 

[Sean]

The program consisted of 7 self-directed learning modules, each requiring approximately 1 hour to complete, focused on addressing maladaptive beliefs related to pain and recovery, as well as practical strategies to enhance coping and management of pain.

No need to establish whether there actually are any "maladaptive beliefs", and that they are affecting recovery to any meaningful degree?

Just assume it is a thing? Decree it to be so?

Interpretation: Among adults with an operatively managed extremity fracture, app-based CBT did not reduce the risk of persistent postsurgical pain over 12 months. Future research is warranted to develop more effective CBT approaches for adults with extremity fractures and to evaluate alternative supportive interventions that may be more acceptable to patients with fracture.

So it didn't work at all, thereby failing to not only verify the 'therapy', but also the underlying assumptions about maladaptive beliefs that need correcting, yet this justifies even more research funds and patients' lives being wasted on pursuing this null result.

Nothing succeeds in psychosomatics like complete failure. The new gold standard in medicine, by which anything is possible.