Nathan Brookes

Conflicts of interest: No conflicts of interest Sources of funding: This work was supported by a Grant from the Chartered Society of Physiotherapy Charitable Trust (Grant number: PRF-23A-PRE04) Background: Conservative strategies for chronic neck pain (CNP) demonstrate modest effects, prompting the adaptation of Cognitive Muscular Therapy (CMT), a novel intervention for CNP. CMT integrates biomechanical retraining to reduce muscle overactivity and improve whole-body postural control, within a framework of psychologically informed physiotherapy. A randomised controlled feasibility trial was undertaken to assess the feasibility of a trial comparing CMT with best practice PIP (psychoeducation, exercise and relaxation). Four patient and public involvement and engagement (PPIE) members with lived experience of CNP, helped shape the trial and its findings. This embedded qualitative study explored the acceptability of CMT and PIP from the perspective of participants with CNP. Methods: 19 individual semi-structured interviews were conducted. Firstly, data were inductively coded and secondly, codes relating to acceptability were deductively mapped to Sekhon et al.'s Theoretical Framework of Acceptability. Results: Six themes were constructed that align with domains of Sekhon's framework: Perceived effectiveness of the intervention; Perceived coherence of the intervention; Perceived burden associated with the intervention; Self-efficacy; Affective attitude towards the intervention. Both interventions were generally viewed positively with a greater focus on improvements in pain in the CMT group. The time burden associated with both interventions was acknowledged, however time spent with physiotherapists was valued for building rapport. For both interventions, participants highlighted strategies to improve intervention burden and coherence, including providing materials in multiple formats and providing an intervention roadmap. Conclusion: Both interventions were acceptable to patients with CNP. For a future randomised trial, PIP is a suitable comparator to CMT.

Objectives: This study aimed to explore the lived experiences of people with knee osteoarthritis (KOA) awaiting Total Knee Replacement (TKR). Methods: Fifteen semi-structured interviews were conducted with participants with a diagnosis of KOA. Transcripts were first analysed inductively with reflexive thematic analysis. Inductive themes were deductively aligned to the COM-B model (‘Capability’, ‘Opportunity’, ‘Motivation’ and ‘Behaviour’) to provide additional understanding of how people navigate the management of KOA and their experiences while awaiting surgery. Results: Four inductive themes were generated and mapped into the COM-B component. (1) ‘Altered health beliefs drive a biomedical focus on KOA management’ (Capability): participants largely understood KOA as an inevitably degenerative condition culminating in surgery. (2) ‘Interactions with healthcare professionals reinforce surgical inevitability’ (Opportunity): participants described clinical encounters that strengthened their biomedical interpretations and shaped expectations of surgery as the primary solution. (3) ‘The emotional burden of KOA’ (Motivation): emotional strain contributed to decisions to pursue surgery. (4) ‘Coping strategies for managing KOA pain’ (Behaviour): participants employed a range of self-directed strategies to manage symptoms while awaiting surgery, often with limited guidance. Conclusion: This study provides a novel, theory-informed understanding of how people awaiting TKR make sense of, engage with, and manage KOA. Using the COM-B model to map these experiences illustrates how current pathways can unintentionally weaken motivation and opportunity to engage with evidence-based first-line interventions like exercise. These findings indicate the value of supporting people with KOA to better understand and access first-line options before considering surgery.