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为慢性非特异性颈部疼痛患者共同开发一个基于证据、理论驱动的运动计划(EPIC-Neck计划——“通过协同设计改进运动处方”)。

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").

作者信息

Price Jonathan, Rushton Alison, Ives Natalie, Jolly Kate, Greaves Colin

机构信息

Musculoskeletal Physiotherapy Services, Birmingham Community Healthcare NHS Foundation Trust, Birmingham, UK.

School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK.

出版信息

BMC Musculoskelet Disord. 2025 Jul 18;26(1):689. doi: 10.1186/s12891-025-08918-z.


DOI:10.1186/s12891-025-08918-z
PMID:40682058
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.

摘要

背景:指南推荐颈部锻炼作为慢性非特异性颈部疼痛的关键干预措施,但目前的锻炼方案效果一般,患者参与度也较低。本研究旨在共同开发一种能最大限度提高有效性和参与度的颈部锻炼方案。 方法:采用干预映射步骤1至4,并纳入了不同患者群体(n = 17)的意见。在步骤1中,从文献和患者研讨会上综合提炼出干预旨在改善的结果/变化。为了最大限度提高参与度,步骤2从临床指南、文献和患者研讨会上确定了目标行为(绩效目标)及其决定因素。在步骤3中,使用理论与技术工具及患者研讨会为每个决定因素选择改变技巧。这些技巧被组织成一个逻辑模型,并置于一个“最适合”的现有行为改变理论框架内,以指导临床实践。为了最大限度提高有效性,步骤2从系统评价和专家共识中确定锻炼目标,描述锻炼影响结果的机制。步骤3确定最有效的锻炼方法和调整策略,以优化锻炼目标。在步骤4中,与患者和物理治疗师共同开发支持临床实践实施的资源。 结果:EPIC-Neck干预旨在根据患者个体需求改善包括疼痛、残疾、功能、睡眠、心理健康和关系影响等方面的结果。一个生物心理社会锻炼处方框架为锻炼调整提供依据,以优化神经肌肉功能、疼痛自我效能感、夜间疼痛、认知控制、社会支持;并根据患者期望的结果减少灾难性思维/恐惧回避。患者需要实现四个绩效目标才能通过锻炼有效管理颈部疼痛:(1)进行特定的颈部锻炼,(2)独立调整和推进颈部锻炼,(3)在疼痛发作时使用特定的颈部锻炼,(4)开始进行一般锻炼。为了最大限度提高参与度,基于生活方式行为改变过程模型开发了一份促进指南。该指南使用24种改变技巧解决35个决定因素,包括目标设定、动机增强、社会支持、行动计划、自我监测、问题解决支持、共同决策和以患者为中心的沟通。 结论:本研究共同开发了一个基于证据、理论驱动的锻炼方案,旨在提高有效性和患者参与度。未来的工作将评估其对患者和物理治疗师的可行性和可接受性,并长期确定其临床和成本效益。

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Lancet. 2024-5-18

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