Effects of Telerehabilitation and Supervised Clinic Based Rehab With Pain Neuroscience Education for Pain,Kinesiophobia and Functional Disability Among Chronic Non-Specific Neck Pain Patients

Overview

Chronic non-specific neck pain is a common musculoskeletal condition affecting a large proportion of the population worldwide. It is characterized by persistent neck pain lasting more than three months without a specific underlying pathology. Many patients experience ongoing symptoms such as pain, reduced range of motion, functional limitations, and psychological factors like kinesiophobia, which can negatively affect recovery and quality of life. Conventional physiotherapy, including supervised clinic-based rehabilitation, is widely used for the management of chronic non-specific neck pain. These programs typically involve exercise therapy and patient education; however, access to regular in-clinic treatment can be limited due to factors such as travel, cost, and time constraints. Telerehabilitation has emerged as an alternative approach that allows delivery of physiotherapy services through online platforms, improving accessibility and convenience for patients. In addition, pain neuroscience education (PNE) is an evidence-based strategy that helps patients understand pain mechanisms, reduce fear-avoidance behaviors, and improve treatment outcomes when combined with exercise therapy. Although both telerehabilitation and supervised clinic-based rehabilitation are effective, there is limited evidence directly comparing these two approaches when combined with standardized pain neuroscience education. Therefore, this randomized controlled trial aims to compare the effects of telerehabilitation with pain neuroscience education and supervised clinic-based rehabilitation with pain neuroscience education on pain intensity, functional disability, and kinesiophobia in individuals with chronic non-specific neck pain.

Chronic non-specific neck pain is a highly prevalent musculoskeletal condition characterized by persistent pain in the cervical region without a specific identifiable pathology. It is a major contributor to disability worldwide and is commonly associated with physical impairments such as reduced cervical mobility, muscle dysfunction, and postural alterations. In addition to physical limitations, psychological factors such as fear of movement (kinesiophobia) and maladaptive pain beliefs play a significant role in the persistence of symptoms and delayed recovery. Conventional management of chronic non-specific neck pain primarily involves supervised clinic-based physiotherapy, including therapeutic exercises and patient education. While these approaches are effective, their implementation may be limited by barriers such as accessibility, travel requirements, cost, and time constraints, particularly in low-resource settings. Telerehabilitation has emerged as an alternative mode of delivering physiotherapy services using digital platforms. It allows remote supervision, guidance, and monitoring of patients, thereby improving accessibility and convenience. Current evidence suggests that telerehabilitation may provide comparable outcomes to face-to-face rehabilitation in musculoskeletal conditions; however, variability in treatment protocols and limited high-quality comparative studies restrict definitive conclusions. Pain neuroscience education (PNE) is an evidence-based educational approach that aims to improve patients' understanding of pain by explaining underlying neurophysiological mechanisms, including central sensitization. It helps reduce fear-avoidance behaviors, correct maladaptive beliefs, and enhance patient engagement in rehabilitation. When combined with exercise therapy, PNE has demonstrated beneficial effects on both physical and psychological outcomes in individuals with chronic pain. Despite the growing use of telerehabilitation and the recognized benefits of integrating PNE into rehabilitation programs, there is limited evidence directly comparing telerehabilitation and supervised clinic-based rehabilitation when both interventions are delivered with standardized PNE content. This study is designed as a randomized controlled trial to compare two modes of intervention delivery: telerehabilitation with pain neuroscience education and supervised clinic-based rehabilitation with pain neuroscience education. Both groups will receive a structured program consisting of therapeutic exercises targeting cervical and scapular musculature along with standardized PNE sessions. The interventions will be delivered over a defined period, with the primary distinction being the mode of delivery (remote versus in-person supervision). The study aims to evaluate whether telerehabilitation can achieve outcomes comparable to supervised clinic-based rehabilitation when both are combined with pain neuroscience education. By addressing both physical and psychological aspects of chronic pain, this study adopts a biopsychosocial approach to management. The findings of this study are expected to contribute to evidence-based physiotherapy practice by identifying an effective and accessible mode of delivering rehabilitation for individuals with chronic non-specific neck pain, particularly in settings where access to in-person care is limited.