Effects of Education and Exercise on Pain, Psychosocial Factors, and Upper Limb Function in Non-specific Neck Pain.
NCT ID: NCT06889389
Last Updated: 2025-12-29
Study Results
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Basic Information
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RECRUITING
NA
81 participants
INTERVENTIONAL
2025-03-28
2026-10-30
Brief Summary
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Detailed Description
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DESIGN The study consists of a randomised, double-blind clinical trial. Subjects will be randomised into 3 groups: control group, where subjects will receive a placebo (TENS off, in this case); intervention group 1, where pain neuroscience education (PNE) and exercise will be applied; and intervention group 2, to which only exercise will be applied. The allocation will be blinded to the subject and to one of the two investigators. SELECTION CRITERIA Inclusion criteria: o Adults aged between 18 and 65 years. o Subjects with non-specific neck pain at the time of the intervention reaching at least a 3 on the Numerical Pain Rating Scale (NPRS scale). Exclusion criteria: o Pregnancy o Severe illnesses: diabetes, cancer, neurological, depression, etc... o Cognitive disorders or illnesses. o Subjects who have received physiotherapy treatment in the last month. o Subjects who are receiving concomitant physiotherapy treatment for this pathology. o Subjects with specific neck pain, such as any traumatic pathology, whiplash or with a diagnosis associated with neurological compromise or peripheral nerve damage. o Physiotherapy students or professional physiotherapists. Subjects included in the study must complete the informed consent form, meet the inclusion criteria and not meet the exclusion criteria. Prior to any type of procedure, subjects will be informed about the study and about their right to discontinue their participation and/or request the withdrawal of their data at any time.
DESCRIPTION OF THE PROCEDURE At the beginning, all subjects will sign the informed consent form, demographic data will be recorded by means of an interview and a questionnaire specifically designed for the work. After that, baseline measurements of outcome variables will be taken. Fear of movement and kinesiophobia will be measured with the Tampa Scale of Kinesiophobia (TSK- 11SV), pain catastrophizing with the Pain and Catastrophizing Scale (PCS), and subject's beliefs about pain with the Pain Beliefs Questionnaire (PBQ). The Spanish validated versions of all the aforementioned scales will be used. The Numerical Pain Rating Scale (NPRS) will be used to assess subjects' current pain and spontaneous or evoked pain intensity. Researcher A will then show each subject images of the 3 performance tests they will have to perform, as well as provide an explanation of their execution: Closed Kinetic Chain Upper Extremity Stability Test (CKCUEST), Single Arm Military Press (SAMP) and Seated Medicine Ball Throw Test (SMBT). Regardless of whether subjects are later assigned to the exercise group or not. These tests are among the most widely used tests to measure upper limb function, although they have not been studied in subjects with non-specific neck pain. The Single Arm Military Press (SAMP) test is the only performance-based measure of upper limb disability that was designed specifically for subjects with neck pain. All these tests involve active movements that could be conditioned by the subject's pain and beliefs related to kinesiophobia, so they could be of great use to observe whether an educational approach decreases upper limb dysfunction. Finally, subjects' beliefs about the exercises explained in relation to their pathology will be assessed by means of a questionnaire specifically designed for this purpose. After this procedure is completed by all participants, they will be randomised into three groups, using a randomisation website (Research Randomizer, n.d.) and will undergo a physiotherapy session that includes different approaches for each group.
In the PNE and exercise group the investigator will proceed with pain neuroscience education focused on concepts related to movement-related fear and the benefits of exercise for 20 minutes. Specifically, the exercises presented in the generic part of the procedure will be discussed. To assess whether the education has resulted in changes to the subjects' beliefs, they will be reassessed regarding their beliefs about the exercises in relation to their neck pain following the education session. Afterward, subjects will complete psychosocial scales and rate their pain and evoked pain at that moment independently, without the need for the researcher to be present, in order to ensure blinding. Subsequently, the subject will undergo the performance tests in a randomised order (Closed Kinetic Chain Upper Extremity Stability Test, Single Arm Military Press, and Seated Medicine Ball Throw), which will be conducted by a second investigator who is unaware of whether the subject has received education. The exercise intervention will then proceed using variations of the performance tests, also carried out by the second investigator. Specifically, the load or execution time will be increased until the participant reports a perceived fatigue of 4-6 (moderate to strong) on the modified Borg scale. Finally, the participant will autonomously complete the scales, rate their pain and exercise-related questions for the final time.
The exercise group does not include pain neuroscience education. Following the initial assessment, the subject will be left alone for 20 minutes with instructions to think about the exercises but not to perform them. Afterward, subjects will complete psychosocial scales and will rate their pain and evoked pain at that moment independently, without the need for the researcher to be present, in order to ensure blinding. Subsequently, the subject will undergo the performance tests in a randomised order (Closed Kinetic Chain Upper Extremity Stability Test, Single Arm Military Press, and Seated Medicine Ball Throw), which will be conducted by a second investigator who is unaware of whether the subject has received education. The exercise intervention will then proceed using variations of the performance tests, also carried out by the second investigator. Specifically, the load or execution time will be increased until the participant reports a perceived fatigue of 4-6 (moderate to strong) on the modified Borg scale. Finally, the participant will independently complete the scales, rate their pain, evoked pain, and exercise-related questions one final time.
The control group does not receive pain neuroscience education or exercise. Following the initial assessment, the subject will be left alone for 20 minutes with instructions to think about the exercises but not to perform them. Afterward, subjects will independently complete psychosocial scales and will rate their pain and evoked pain at that moment, without the need for the researcher to be present, in order to ensure blinding. Subsequently, participants in this group will receive a placebo intervention administered by a second investigator. A TENS device will be placed on them and kept turned off for 15 minutes. subjects will be informed that the device is operating at a very low intensity, too weak to be perceived. Additionally, performance tests will not be assessed in this group. Finally, the participant will autonomously complete the scales, rate their pain and exercise-related questions for the final time. Therefore, all groups will be assessed 3 times during the session. The first time they will be accompanied by the first investigator, who will answer any questions that may arise. The second and third time the subject will do it autonomously, unaccompanied by any researcher, to avoid bias.
Conditions
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Keywords
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Study Design
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RANDOMIZED
PARALLEL
TREATMENT
DOUBLE
Study Groups
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Education and Exercise group
The investigator will proceed with pain neuroscience education focused on concepts related to movement-related fear and the benefits of exercise for 20 minutes. Specifically, the exercises presented in the generic part of the procedure will be discussed. To assess whether the education has produced changes in the subjects' beliefs, they will be reassessed regarding their beliefs about the exercises in relation to their neck pain following the education session. Subsequently, the subject will undergo the performance tests (Closed Kinetic Chain Upper Extremity Stability Test, Single Arm Military Press, and Seated Medicine Ball Throw), which will be carried out by a second investigator. The exercise intervention will then proceed using variations of the performance tests, also conducted by the second investigator. Specifically, the load or execution time will be increased until the participant reports a perceived fatigue of 4-6 (moderate to strong) on the modified Borg scale.
Education
The intervention consists of 20 minutes of pain neuroscience education, focused on concepts related to movement-related fear and the benefits of exercise for managing pain. Specific exercises, mentioned in the generic part of the procedure, will be discussed during this session. This intervention aims to modify the subjects' beliefs regarding exercises and their neck pain.
Excercise
The exercise intervention includes performance tests and variations of these tests used as exercises, such as the Closed Kinetic Chain Upper Extremity Stability Test, Single Arm Military Press, and Seated Medicine Ball Throw. Variations of these performance tests will be implemented, with adjustments made to the load or execution time until the participant reports a perceived fatigue of 4-6 (moderate to strong) on the modified Borg scale.
Exercise group
This group does not include pain neuroscience education. Following the initial assessment, the subject will be left alone for 20 minutes with instructions to think about the exercises but not to perform them. Subsequently, the subject will undergo the performance tests (Closed Kinetic Chain Upper Extremity Stability Test, Single Arm Military Press, and Seated Medicine Ball Throw), which will be carried out by a second investigator. The exercise intervention will then proceed using variations of the performance tests, also conducted by the second investigator. Specifically, the load or execution time will be increased until the participant reports a perceived fatigue of 4-6 (moderate to strong) on the modified Borg scale.
Excercise
The exercise intervention includes performance tests and variations of these tests used as exercises, such as the Closed Kinetic Chain Upper Extremity Stability Test, Single Arm Military Press, and Seated Medicine Ball Throw. Variations of these performance tests will be implemented, with adjustments made to the load or execution time until the participant reports a perceived fatigue of 4-6 (moderate to strong) on the modified Borg scale.
Control group
This group does not include pain neuroscience education or exercise. Following the initial assessment, the subject will be left alone for 20 minutes with instructions to think about the exercises but not to perform them. Subsequently, subjects in this group will receive a placebo intervention. A TENS device will be placed on them and kept turned off for 15 minutes. Subjects will be informed that the device is working at a very low intensity, too weak to be perceived. Additionally, performance tests will not be assessed in this group.
Placebo
The placebo intervention involves the application of a TENS device, which will be placed on the participant and kept turned off for 15 minutes. Subjects will be informed that the device is working at a very low intensity, too weak to be perceived. This intervention aims to simulate the experience of treatment without delivering any therapeutic effect.
Interventions
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Education
The intervention consists of 20 minutes of pain neuroscience education, focused on concepts related to movement-related fear and the benefits of exercise for managing pain. Specific exercises, mentioned in the generic part of the procedure, will be discussed during this session. This intervention aims to modify the subjects' beliefs regarding exercises and their neck pain.
Excercise
The exercise intervention includes performance tests and variations of these tests used as exercises, such as the Closed Kinetic Chain Upper Extremity Stability Test, Single Arm Military Press, and Seated Medicine Ball Throw. Variations of these performance tests will be implemented, with adjustments made to the load or execution time until the participant reports a perceived fatigue of 4-6 (moderate to strong) on the modified Borg scale.
Placebo
The placebo intervention involves the application of a TENS device, which will be placed on the participant and kept turned off for 15 minutes. Subjects will be informed that the device is working at a very low intensity, too weak to be perceived. This intervention aims to simulate the experience of treatment without delivering any therapeutic effect.
Other Intervention Names
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Eligibility Criteria
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Inclusion Criteria
* Subjects with non-specific neck pain at the time of the intervention, scoring at least 3 on the NPRS scale.
Exclusion Criteria
* Severe illnesses: diabetes, cancer, neurological conditions, depression, etc.
* Subjects impairments or disorders
* Subjects who have received physiotherapy treatment within the last month
* Subjects currently undergoing concurrent physiotherapy treatment for this condition
* Subjects with specific neck pain, such as any traumatic pathology, whiplash, or diagnoses associated with neurological compromise or peripheral nerve damage
* Physiotherapy students or professional physiotherapists
18 Years
65 Years
ALL
No
Sponsors
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Universidad Miguel Hernandez de Elche
OTHER
Responsible Party
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Jaime Gascón Jaen
Principal Investigator
Locations
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Clínica de Franscisco Ortega Rehabilitación Avanzada S.L.
Elche, Alicante, Spain
Countries
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Central Contacts
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Facility Contacts
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Francisco-Javier Ortega-Puebla, Physiotherapist
Role: primary
References
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Provided Documents
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Document Type: Study Protocol and Statistical Analysis Plan
Document Type: Informed Consent Form
Other Identifiers
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DPC.JGJ.241001
Identifier Type: OTHER
Identifier Source: secondary_id
PI 90/2024
Identifier Type: -
Identifier Source: org_study_id