Co-development of an evidence-informed, theoretically driven exercise programme for people with chronic non-specific neck pain (the EPIC-Neck programme - “Exercise Prescription Improved through Co-design”)
Bibliographic record
Abstract
BACKGROUND: Guidelines recommend neck exercise as a key intervention for chronic non-specific neck pain, yet current exercise programmes show modest effects and poor patient engagement. This study aimed to co-develop a neck exercise programme that maximizes effectiveness and engagement. METHODS: Intervention Mapping steps 1-4 were employed with input from a diverse patient group (n = 17). In Step 1, outcomes/changes that the intervention aims to improve were synthesized from literature and patient workshops. To maximise engagement, Step 2 identified target behaviours (performance objectives), and their determinants from clinical guidelines, literature, and patient workshops. In Step 3, change techniques for each determinant were selected using the Theory and Techniques Tool and patient workshops. Techniques were organized into a logic model and framed within a "best fit" existing behaviour change theory to guide clinical practice. To maximise effectiveness, Step 2 identified exercise objectives from systematic reviews and expert consensus, describing the mechanisms through which exercise affects outcomes. Step 3 identified the most effective exercises and tailoring strategies to optimise exercise objectives. Resources to support delivery in clinical practice were co-developed with patients and physiotherapists in Step 4. RESULTS: The EPIC-Neck intervention aims to improve outcomes including pain, disability, function, sleep, mental well-being and relationship impact, based on individual patient needs. A biopsychosocial exercise prescription framework informs exercise tailoring to optimize neuromuscular function, pain self-efficacy, night pain, cognitive control, social support; and reduce catastrophic thinking/fear avoidance, depending on a patients desired outcome. Patients need to achieve four performance objectives to manage neck pain effectively with exercise: (1) performing specific neck exercises, (2) independently adapting and progressing their neck exercises, (3) using specific neck exercises during flare-ups, and (4) initiating general exercise. To maximise engagement, a facilitation guide was developed based on the Process Model of Lifestyle Behaviour Change. The guide addresses 35 determinants using 24 change techniques, including goal setting, motivation enhancement, social support, action planning, self-monitoring, problem-solving support, shared decision-making, and patient-centred communication. CONCLUSION: This study co-developed an evidence-informed, theoretically driven exercise programme designed to enhance both effectiveness and patient engagement. Future work will assess its feasibility and acceptability to patients and physiotherapists, and in the long-term establish its clinical and cost-effectiveness.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.042 | 0.050 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.003 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.002 | 0.008 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.004 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".