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Contact Information:

Mr Nathan Brookes
+44 (0)7790 912929
n.brookes1@salford.ac.uk


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Be Part of Research - Trial Details - A clinical study comparing two types of psychologically informed physiotherapy for people with long term non-specific neck pain
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A clinical study comparing two types of psychologically informed physiotherapy for people with long term non-specific neck pain

Recruiting

Open to: All Genders

Age: Adult

Salford Salford

Medical Conditions

Non-specific neck pain

This information is provided directly by researchers, and we recognise that it isn't always easy to understand. We are working with researchers to improve the accessibility of this information. In some summaries, you may come across links to external websites. These websites will have more information to help you better understand the study.


Chronic neck pain (CNP) is a common long-term condition resulting in pain, disability and reduced quality of life. It is the fourth leading musculoskeletal cause of disability in the UK, yet it receives less research attention compared to other common conditions like low back pain. Current management typically involves a combination of advice, pain relief, and physiotherapy. However, recent reviews suggest that while this approach may result in short-term improvements, long-term effects are limited, requiring more effective interventions.
Emerging research has highlighted increased levels of muscle tension and altered pain signalling mechanisms in CNP, leading to generalised pain sensitivity and altered pain tolerance. Emotional responses further contribute to pain experiences and affect participation in physical activity. Current mainstream physiotherapy approaches for CNP do not prioritise psychological aspects of the pain experience. However, early research suggests their significance, therefore these factors warrant further consideration.
Current physiotherapy mainly focuses on manual therapy (massage/ manipulation) and exercise (strength, stretches). This approach does not directly target muscle overactivity and psychological involvement in pain, possibly explaining limited success. Research has demonstrated that electromyography (EMG) biofeedback shows promise in reducing CNP. Therefore, interventions combining biofeedback and psychological elements may be important.
A novel approach, Cognitive Muscular Therapy (CMT), combines psychologically informed practices with muscle biofeedback training to reduce muscle overactivity and alter pain-related beliefs. Initial application on five CNP patients demonstrated substantial improvement in pain and function with participants acknowledging newfound insights into their pain experiences.
This study aims to conduct a feasibility study comparing CMT with psychologically informed physiotherapy (education, pacing, exercise and self-management) for CNP patients at risk of long-term disability.
In summary, CNP management requires new approaches that address its complex nature. CMT shows promise but further rigorous evaluation is required through comprehensive clinical trials.
The aim of this study is to compare two new physiotherapy approaches for long-term neck pain. The two treatments both use psychological techniques and have either been shown to be effective for treating other chronic pain conditions or have some degree of proven benefit for neck pain. The researchers aim to measure the change in pain and function after receiving each treatment.

Start dates may differ between countries and research sites. The research team are responsible for keeping the information up-to-date.  

The recruitment start and end dates are as follows:

03 Jun 2024 30 Apr 2025

Participants complete three types of questionnaires before they start the study, at 14 weeks after the start of the study and at 6 months after the start of the study.
1. Neck pain questionnaires: symptoms, daily life impact, and emotional aspects of neck pain.
2. Healthcare access questionnaires: about healthcare service use, such as GP visits.
3. Demographic information: information on age, ethnicity, socio-economic status, gender, disability, and religion.
After the questionnaires are completed, participants will be allocated randomly to one of two groups. Participants in treatment group 1 will receive the treatment over seven face-to-face physiotherapy sessions. The physiotherapist will first complete a physical assessment using muscle sensors. They will then explain how reacting and thinking differently about the condition has the potential to reduce pain. Participants will be taught how to consciously relax their neck, shoulder and stomach muscles and will learn how to maintain this relaxation in sitting, standing and during everyday movements. To help with the learning of new muscle patterns, the physiotherapist will use small sensors which visualise the patient's muscle patterns on a screen. Instructional videos are used to explain different parts of the treatment which are watched on a tablet or laptop computer. If patients don’t have a tablet computer, they will be loaned one. If they are unable to use a tablet computer, they will be provided with written materials.
Participants in treatment group 2 will receive five face-to-face physiotherapy sessions and two online sessions. The physiotherapist will first assess the patient's movement and strength and then teach them gentle stretches for their neck, back, arms and legs. They will then be taught about pain and how lifestyle factors, such as sleep, diet and stress, may contribute to pain. Building on these ideas, they will be taught relaxation and mindfulness techniques and then provided with exercises designed to improve flexibility, strength, and balance. They will also be taught about the use of pacing to remain active and manage their pain and how to manage flare-ups. Again, instructional videos are used to explain different parts of the treatment which are watched on a tablet or laptop computer. If patients don’t have a tablet computer, they will be loaned one. If they are unable to use a tablet computer, they will be provided with written materials.
After receiving the treatment, the researchers will select (through pain outcomes) a subset of 10 participants from each group, who together demonstrate a range of clinical responses. We will also select two participants who have withdrawn from the study. Each participant will be interviewed by an experienced independent qualitative researcher who did not take part in the intervention delivery to explore intervention acceptability. Interviews will be carried out over the phone or via video conference and will be guided by a topic guide.


People aged 18- 100 years who have a 3-month history of neck pain and are able to stand for 10 minutes

You can take part if:



You may not be able to take part if:


1. Diagnosis of inflammatory arthritis (e.g. rheumatoid arthritis, psoriatic arthritis) 2. Previous spinal surgery such as discectomy, anterior cervical discectomy and fusion, disc replacement, laminectomy and scoliosis fixation3. Diagnosis of degenerative neurological disorders (e.g. multiple sclerosis/Parkinson's)4. Vulnerable patients for example those who lack the mental capacity to make decisions, have dementia or are nearing the end of life5. BMI of more than 33 (as increased subcutaneous fat prevents the collection of surface EMG signals)6. Pending litigation related to an injury for example at work or whilst driving7. Unable to cancel or postpone other treatment that is being received for the condition, for example, physiotherapy, chiropractic or osteopathy


Below are the locations for where you can take part in the trial. Please note that not all sites may be open.

  • University of Salford Frederick Road Campus
    University of Salford Allerton Building Frederick Road Campus
    Salford
    M6 6PU
  • Northern Care Alliance NHS Foundation Trust
    Stott Lane Salford Greater Manchester
    Salford
    M6 8HD

Participants may benefit from improved pain, function and/or self-management of their condition. There is a slight risk of musculoskeletal pain in the form of delayed onset muscle soreness (DOMS). Patients will be advised about this by the physiotherapist who will explain the concept of delayed onset muscle soreness and how this should improve in 2-3 days and reduce following repeated completion of the exercise. Any discomfort that is prolonged will be noted as an adverse event and adaptations to the treatment will be agreed upon with the patient, for example reducing the weight or number of repetitions of exercise.

Mr Nathan Brookes
+44 (0)7790 912929
n.brookes1@salford.ac.uk



The study is sponsored by University of Salford and funded by Chartered Society of Physiotherapy Charitable Trust.



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Read full details for Trial ID: ISRCTN14479543

Or CPMS 61544

Last updated 10 April 2025

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