Colin James Greaves

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

Objectives The Rehabilitation Enablement in Chronic Heart Failure (REACH-HF) programme is an evidence-based, healthcare professional-facilitated, home-based cardiac rehabilitation intervention for people living with heart failure. Digital training may provide a scalable approach to preparing healthcare professionals to deliver REACH-HF. This study aimed to describe observed patterns of fidelity across REACH-HF intervention components following digital training, and to explore healthcare professional views of the training’s feasibility, acceptability and usability and its perceived influence on intervention delivery. Design Mixed-methods implementation evaluation combining descriptive assessment of fidelity with semi-structured interviews analysed using reflexive thematic analysis. Setting Five National Health Service cardiac rehabilitation services in England. Participants 15 healthcare professionals were recruited, 14 completed the digital training and 7 subsequently delivered REACH-HF. Fidelity data comprised 17 audio-recorded intervention sessions delivered by six facilitators. 11 healthcare professionals participated in the semi-structured interviews. Intervention Co-designed training programme to train healthcare professionals as facilitators of the REACH-HF programme. Delivered in a hybrid format with self-paced learning modules accessible via a bespoke eLearning platform (asynchronous) with subsequent 3-hour virtual group session (synchronous) to complete the training. Outcome measures Competence of REACH-HF delivery, assessed using an established intervention fidelity checklist, alongside qualitative inquiry concerning healthcare professional experiences of the training, including its feasibility, acceptability and usability, and its perceived influence on intervention delivery. Results Adequate fidelity was observed across most REACH-HF components. Delivery was strongest for patient involvement, the physical activity programme and programme closure; competent delivery was observed for needs assessment, tailored planning, understanding of heart failure and progress monitoring. Lower scores were seen for emotional support, medication-related discussions and active exploration of caregiver involvement. Caregiver emotion and well-being could not meaningfully be assessed due to limited caregiver presence. Facilitators generally perceived the training as usable and valuable, but engagement and preparedness were shaped by prior experience, perceived relevance and service pressures affecting protected training time. Confidence was consolidated primarily through real-world delivery rather than training completion alone. Non-delivery reflected constrained operational opportunities rather than a consistent difference in confidence or preparedness. Conclusion Co-designed digital training may support healthcare professional preparation for REACH-HF delivery. Further research with larger and more complete fidelity datasets is required before firm conclusions can be drawn about overall delivery fidelity or equivalence with face-to-face training. Translating digital training into practice requires protected time for training and intervention delivery, timely opportunities for delivery and ongoing practical and organisational support.

Background: Managing multiple long-term conditions (MLTCs) within individuals is a key global public health priority. Psychological interventions are effective in improving mental health outcomes in single-condition populations, yet the evidence for adults with MLTCs remains scarce. This scoping review aimed to map existing evidence on psychological interventions for people with MLTCs, highlight literature gaps and offer recommendations for future research, practice, and policy. Methods: The pre-registered review follows Arksey & O’Malley’s (2005) framework and is reported in line with the PRISMA-ScR guidelines. We searched six databases (PubMed, Embase, Scopus, Cochrane, PsycNET, Web of Science) up to January 2025, including reference screening and a grey literature search. After screening 124 full texts, 54 studies were included. Eligible studies evaluated any psychological intervention in adults with two or more long-term health conditions and included a validated psychological health outcome. Results: Existing research primarily focusses on a handful of chronic conditions (diabetes, cardiovascular disease, chronic pain), often alongside comorbid depression. Cognitive-behavioural therapy (CBT) and behavioural activation (BA) are the most frequently evaluated interventions, generally demonstrating positive effects on mental health and acceptability to patients. The evidence base has progressed from early-stage development and feasibility studies to effectiveness trials, though economic evaluations and implementation research are still scarce. Notable gaps include limited research on transdiagnostic approaches, underserved populations and studies involving healthcare providers and carers. Most studies are concentrated in Western countries, highlighting a need for broader geographic representation, particularly in the global South. Conclusions: Psychological interventions such as CBT and BA show promise for individuals with MLTCs, but significant gaps remain. Future research should i) prioritise inclusive, transdiagnostic approaches to MLTC management, ii) expand geographic diversity, iii) use data-driven approaches to identify and intervene on common MLTC clusters and iv) incorporate health economic and implementation considerations to support more effective and equitable mental health care for those living with MLTCs.

Objectives: To provide an updated systematic review of the effectiveness of workplace interventions for chronic musculoskeletal disorders, identify key intervention components and assess their impact on health and work-related outcomes. Design: Systematic review of randomised controlled trials. Data sources: MEDLINE, EMBASE, CINAHL, PsycINFO, Scopus and Web of Science were searched for studies published between 2018 and 2024. Grey literature sources were also consulted. Eligibility criteria: Randomised controlled trials and cluster-randomised trials evaluating workplace interventions targeting adults with chronic musculoskeletal disorders were included. Outcomes of interest included pain, functional outcomes, quality of life and work-related outcomes (eg, work ability, productivity, presenteeism and absenteeism). Data extraction and synthesis: Two reviewers independently screened studies, extracted data and assessed risk of bias using the Cochrane Risk of Bias 2 tool. Due to heterogeneity, only a narrative synthesis was conducted. Results: 23 studies involving 2456 participants were included and classified into physical exercise, ergonomic and multicomponent interventions. Physical exercise interventions consistently improved pain and functional outcomes. Digital delivery of exercise interventions demonstrated comparable effectiveness to face-to-face or workplace-based approaches. Multicomponent interventions, combining exercise with ergonomic strategies, demonstrated the most consistent benefits across outcomes. Evidence for work-related outcomes was limited and inconsistent, and quality of life was assessed in only a small number of studies. Conclusions: Workplace interventions, particularly multicomponent approaches combining exercise, ergonomics and education, can be effective in improving health outcomes in chronic musculoskeletal disorders. However, evidence on work-related outcomes remains limited and inconsistent. PROSPERO registration number: CRD420261289218.

A novel ‘whole day’ approach that could motivate the public to be more physically active is termed Snacktivity™. Consistent with guidance

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. 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. 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. 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.

Aims: To understand the self-management experiences of people with heart failure with preserved ejection fraction, their caregivers, and the healthcare professionals who support them. Methods: A systematic review of qualitative and mixed-methods literature, published up until July 2023. A total of 4560 abstracts were identified and screened, describing patients’, caregivers’, and healthcare professionals’ experiences of self-management strategies for heart failure with preserved ejection fraction. Of the 349 full texts, the authors included seven papers from three data sources (including 47 patients, 81 caregivers, 129 healthcare professionals) in the final data set. Key theories, methods and results were extracted, reviewed and synthesised using meta-study techniques. Results: Heart failure with preserved ejection fraction is difficult for healthcare professionals to diagnose, and difficult for patients and their caregivers to understand. Patients and caregivers can struggle to access support, which can lead to a ‘cycle of decline’ over time in patients’ outcomes and quality of life. However, when the burdens of understanding heart failure with preserved ejection fraction and self-management are acknowledged, when personalised goals are set and when feedback is provided, individualised self-management can be optimised. Conclusions: Disempowerment and loss of control can result from the limited capacity of healthcare professionals to support patients with heart failure with preserved ejection fraction and of caregivers to develop effective self-management understanding and practice. Tailored interventions are required to maximise healthcare professionals’ enablement of patients and their caregivers to develop flexible and sustainable self-management strategies. Future research must specify and evaluate the skill set that healthcare professionals require to provide individualised care that is tailored to the holistic needs of people self-managing heart failure with preserved ejection fraction within the local care context.

Background: Despite strong recommendations for heart failure (HF) rehabilitation, participation (uptake and sustained engagement) remains low. Digital interventions may enhance participation and scalability, yet evidence for feasibility in real-world National Health Service settings remains limited. Rehabilitation Enablement in Chronic Heart Failure (REACH-HF), an effective home-based HF cardiac rehabilitation programme, is currently delivered using paper-based manuals with facilitator support. Objectives: To co-develop and assess the feasibility of a digitally adapted and enhanced version of REACH-HF (D:REACH-HF) with patients, caregivers, and healthcare professionals. Methods: Following the Person-Based Approach, D:REACH-HF was iteratively co-developed with patients and caregivers in a public involvement group (stage 1) and through qualitative research (stages 2A and 2B). Usability and acceptability of content and design iterations were evaluated with patients, caregivers, and healthcare professionals through think-aloud interviews ( n = 20 participants) and feasibility of the fully-functional intervention with facilitation, was assessed with semi-structured interviews at 2–4 and 10–12 weeks ( n = 10). Results: Participants rated D:REACH-HF highly (mean app quality score: 4.02/5), particularly for information credibility and functionality. Key benefits included flexibility, structured self-monitoring, and healthcare professional support. Remote access to patient data enabled more efficient consultations, allowing healthcare professionals to focus on tailoring their support to patient needs. Challenges included technical issues, digital literacy, and engagement variability. All patients requested continued access to the platform, highlighting perceived long-term value. Conclusion: The D:REACH-HF programme is acceptable to patients and healthcare professionals. Moreover, as indicated by participant reports, it enables and achieves the same perceived benefits as the paper-based REACH-HF. However, evaluation of clinical and cost-effectiveness, implementation, and optimisation of D:REACH-HF for patients from under-researched and underserved communities is needed.

Summary: Bariatric surgery is an effective treatment for obesity, but long‐term can lead to health‐related issues. Guidelines highlight the importance of long‐term post‐bariatric surgery follow‐up. However, in the UK, there is currently no specific funding to support the delivery of this care. Our aim was to understand the views and experiences of healthcare professionals (HCPs) around long‐term post‐bariatric surgery follow‐up, and barriers and enablers to care. Semi‐structured interviews with HCPs in UK primary care or specialist weight management services were conducted. The topic guide was theoretically informed by the Capability‐Opportunity‐Motivation‐Behaviour model and the Theoretical Domains Framework. Thematic analysis was undertaken. Twenty‐six HCPs were interviewed. Three core themes were interpreted: Existing Challenges, Mediating Factors and Future Directions. While there was agreement on the need for long‐term support, current provision was variable and hampered by a paucity of referral options. Follow‐up care could be contingent upon the patients' surgical pathway and the culture and expertise within the general practitioner surgery. Participants discussed potential ways to improve care, including using technology, adapting approaches used in other chronic conditions, shared care models and harnessing the potential for peer‐based support to improve wellbeing and quality of life. Healthcare professionals' views and experiences shared in this study highlight the complex issues associated with long‐term bariatric surgery follow‐up. The findings will inform future research to design and implement care pathways that are urgently needed to improve service provision for these patients.