The EPIC-Neck programme was co-developed to combine tailored exercise prescriptions and behaviour change techniques, aiming to improve both effectiveness and engagement in managing chronic neck pain.
We used Intervention Mapping principles, collaborating with patients (n=17; diverse in age, gender, ethnicity, socio-economic status, and activity levels), service providers and international neck pain experts.
Step 1 – Identifying outcomes – Patients prioritised candidate outcomes synthesised from the literature and stakeholder workshops.
Step 2A – Identifying exercise mechanisms for effectiveness - The mechanisms by which exercise affects the outcomes from Step 1 were identified from systematic reviews of chronic musculoskeletal pain intervention mediators and expert consensus on neck exercise prescription.
Step 3A – Tailoring exercise for effectiveness - The most effective exercises for the outcomes from Step 1 were identified from systematic reviews and expert consensus. Literature, patient input and clinical experience were used to describe how to tailor exercise to optimise the mechanisms from Step 2A.
Step 2B – Identifying behaviours and barriers to engagement - Exercise behaviours and performance objectives were identified from clinical guidelines, patient workshops and expert consensus. Determinants (barriers and facilitators) for each performance objective were synthesised from systematic reviews and patient workshops.
Step 3B – Specifying techniques to maximise engagement - Change techniques informed by the Theory and Techniques Tool, the Behaviour Change Techniques Taxonomy V1 and patient workshops, were organised within a behaviour change theory to guide delivery in clinical practice.
Step 4 – Co-creating supporting resources - Resources were co-created through workshops involving physiotherapists, patients, creative design experts and mobile application developers.
The EPIC-Neck programme aims to improve pain, disability, function, sleep, mental well-being, and neck pain's impact on relationships. It consists of two components:
Maximising effectiveness - Exercises that restore normal movement and improve neck tolerance are prescribed and tailored to optimise exercise mechanisms of neuromuscular function, fear avoidance, pain self-efficacy, night pain, cognitive control, or social support, depending on the desired outcome.
Maximising engagement - The overarching target is for individuals to engage with the EPIC-Neck programme, achieved via four performance objectives 1) performing the prescribed exercises 2) adapting and progressing exercise independently 3) using exercise during flare-ups and 4) engaging in secondary prevention exercise.
Thirty-five determinants were identified. Based on the process model of lifestyle behaviour change, a facilitation guide outlines 19 change techniques including goal setting, improving motivation and social support, action planning, problem-solving and patient-centred communication. Techniques are supported by a workbook (app/paper) and friends-and-family leaflets.
We co-developed with stakeholders, an evidence-informed, theoretically driven exercise programme (EPIC-Neck programme) to maximise effectiveness and engagement. Feasibility and acceptability are being evaluated.
Co-development provided a robust method for maximising the likely long-term engagement with and effectiveness of exercise.
Co-design
Exercise
