title: Does adding cognitive-behavioural physiotherapy to exercise improve outcome in patients with chronic neck pain? A randomised controlled trial.
abstract: OBJECTIVE
  To determine whether adding a physiotherapist-led cognitive-behavioural intervention to an exercise programme improved outcome in patients with chronic neck pain (CNP).
  
  
  METHODS
  Multicentre randomised controlled trial.
  
  
  METHODS
  Four outpatient physiotherapy departments.
  
  
  METHODS
  Fifty-seven patients with CNP. Follow-up data were provided by 39 participants [57% of the progressive neck exercise programme (PNEP) group and 79% of the interactive behavioural modification therapy (IBMT) group].
  
  
  METHODS
  Twenty-eight subjects were randomised to the PNEP group and 29 subjects were randomised to the IBMT group. IBMT is underpinned by cognitive-behavioural principles, and aims to modify cognitive risk factors through interactive educational sessions, graded exercise and progressive goal setting.
  
  
  METHODS
  The main outcome measure was disability, measured by the Northwick Park Questionnaire (NPQ). Secondary outcomes were the Numeric Pain Rating Scale (NPRS), Pain Catastrophising Scale, Tampa Scale for Kinesiophobia (TSK), Chronic Pain Self-efficacy Scale (CPSS) and the Pain Vigilance and Awareness Questionnaire.
  
  
  RESULTS
  No significant between-group differences in disability were observed (mean NPQ change: PNEP=-7.2, IBMT=-10.2). However, larger increases in functional self-efficacy (mean CPSS change: PNEP=1.0, IBMT=3.2) and greater reductions in pain intensity (mean NPRS change: PNEP=-1.0, IBMT=-2.2; P<0.05) and pain-related fear (mean TSK change: PNEP=0.2, IBMT=-4.7, P<0.05) were observed with IBMT. Additionally, a significantly greater proportion of participants made clinically meaningful reductions in pain (25% vs 55%, P<0.05) and disability (25% vs 59%, P<0.05) with IBMT.
  
  
  CONCLUSIONS
  The primary outcome did not support the use of cognitive-behavioural physiotherapy in all patients with CNP. However, superior outcomes were observed for several secondary measures, and IBMT may offer additional benefit in some patients.
  
  
  BACKGROUND
  ISRCTN27611394.
authors.affiliation: Department of Physiotherapy, The Pennine Acute Hospitals NHS Trust, North Manchester General Hospital, Crumpsall, Manchester, UK. Electronic address: david.thompson@pat.nhs.uk.
authors.forename: D P
authors.initials: DP
authors.lastname: Thompson
authors.affiliation: Manchester Integrating Medicine and Innovative Technology, University of Manchester, UK.
authors.forename: J A
authors.initials: JA
authors.lastname: Oldham
authors.affiliation: Department of Research and Development, The Pennine Acute Hospitals NHS Trust, North Manchester General Hospital, Crumpsall, Manchester, UK.
authors.forename: S R
authors.initials: SR
authors.lastname: Woby
mesh_terms: D000328:Adult; D059350:Chronic Pain / Q000534:rehabilitation*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D004185:Disability Evaluation; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019547:Neck Pain / Q000534:rehabilitation*; D010347:Patient Care Planning; D010353:Patient Education as Topic / Q000379:methods
keywords: Cognitive-behavioural; Exercise; Interactive behavioural modification therapy; Neck pain; Physiotherapy