Co-developed neck exercise (EPIC-Neck) versus usual exercise care for people with chronic non-specific neck pain: a UK multicentre randomised feasibility trial
5 affiliations
- 1Musculoskeletal Physiotherapy Services, Birmingham Community Healthcare NHS Foundation Trust, Aston, UK
- 2Research and Innovation, Birmingham Community Healthcare NHS Foundation Trust, Aston, UK
- 3School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham College of Life and Environmental Sciences, Birmingham, UK
- 4School of Physical Therapy, Western University, London, Ontario, Canada
- 5Institute of Applied Health Research, University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
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
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BibTeX
@article{price2026codeveloped,
title = {{Co-developed neck exercise (EPIC-Neck) versus usual exercise care for people with chronic non-specific neck pain: a UK multicentre randomised feasibility trial}},
author = {Jonathan Price and Alison Rushton and Natalie Ives and Marilyn Bradbury and Priti Parmar and Colin J Greaves},
journal = {BMJ Open},
year = {2026},
month = oct,
doi = {10.1136/bmjopen-2026-120571},
url = {https://bmjopen.bmj.com/lookup/doi/10.1136/bmjopen-2026-120571},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Co-developed neck exercise (EPIC-Neck) versus usual exercise care for people with chronic non-specific neck pain: a UK multicentre randomised feasibility trial
AU - Jonathan Price
AU - Alison Rushton
AU - Natalie Ives
AU - Marilyn Bradbury
AU - Priti Parmar
AU - Colin J Greaves
PY - 2026
DA - 2026/10/20
JO - BMJ Open
DO - 10.1136/bmjopen-2026-120571
UR - https://bmjopen.bmj.com/lookup/doi/10.1136/bmjopen-2026-120571
AB - 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
SN - 2044-6055
SN - 2044-6055
ER -