Co-developed neck exercise (EPIC-Neck) versus usual exercise care for people with chronic non-specific neck pain: a UK multicentre randomised feasibility trial

Authors:
Open Access
Publisher website
Google Scholar
Abstract
Objectives To assess the feasibility of conducting a definitive randomised controlled trial of the EPIC-Neck progamme versus usual exercise care for chronic non-specific neck pain, specifically in relation to recruitment, retention, delivery fidelity, acceptability and contamination. Design Multicentre, two-arm, parallel-group, individually randomised controlled feasibility trial with an embedded process evaluation. Setting Three National Health Service musculoskeletal services in England. Participants Adults (≥18 years) with chronic non-specific neck pain lasting >3 months. Interventions Participants were randomised (2:1) to EPIC-Neck (an individualised, evidence-based, theory informed, co-designed exercise programme) or usual exercise care. Participants and outcome assessors were not blinded to allocation. Feasibility objectives Progression was assessed using predefined green–amber–red criteria across five domains: (1) recruitment rate, (2) retention rate (percentage returning the neck disability index at 6 months), (3) delivery fidelity (audio-recorded appointments scored on a 0–5 Dreyfus competence scale where ≥3 means acceptable), (4) acceptability to participants and physiotherapists (1–5 acceptability questionnaires where ≥4 means acceptable and interviews analysed deductively using framework analysis against the theoretical framework of acceptability) and (5) contamination (presence of EPIC-Neck components in usual care) scored using the same 0–5 Dreyfus competency scale as delivery fidelity. Results Between May 2024 and February 2025, 287 individuals were screened and 36 were randomised (24 EPIC-Neck, 12 usual care), yielding a mean recruitment rate of 4.5 participants/month (green). Retention at 6 months was 67% (24/36) (red). Among participants who completed their allocated treatment, the 6-month retention rate was 91% (22/24). Delivery fidelity was moderate (mean 2.4/5; amber), with only 14% of participants receiving EPIC-Neck at an acceptable level. Acceptability was generally positive, although interviews identified addressable concerns around intervention coherence (amber). Contamination was low (mean fidelity score for controls was 1.1/5; green). Conclusions EPIC-Neck shows potential for evaluation in a definitive trial, but progression is conditional on future refinement of the intervention and study procedures to address the key barriers to progression: retention, delivery fidelity and intervention coherence. Trial registration number ISRCTN81746901
Funding Information
  • National Institute for Health and Care Research (Clinical Doctoral Research Fellow, NIHR302141)

This publication has 89 references indexed in Scilit: