Welcome to Spinal Columns, the weekly newsletter from CANSpine, at the School of Physical Therapy, Faculty of Health Science, Western University. Today is Tuesday, August fifth, twenty-twenty-five. On this week's episode, we're sharing three updates from the group.

The first update centers on a question that both clinicians and patients with chronic neck pain often ask: How can a neck exercise program be designed so it's both more effective and something patients will stick to? A study from Alison Rushton and colleagues addressed this by co-developing an exercise program directly with a group of patients. Using a process that combined patient input with evidence from literature and clinical guidelines, they created the EPIC-Neck intervention. The program is designed to be tailored to a patient's individual needs, targeting outcomes like pain, function, sleep, and mental well-being. To help patients stick with the program, it also includes a facilitation guide for clinicians. This guide uses behavior change techniques like goal setting, motivation enhancement, problem-solving support, and shared decision-making to help patients manage their exercises, adapt them over time, and use them during flare-ups.

Our second update also involves work from Alison Rushton and her colleagues, and it shifts focus from the neck to the lower back, looking at the question: What separates a positive from a fearful recovery after back surgery? To get insight into this, the research team conducted a qualitative study with 14 patients who had undergone a lumbar discectomy. Through semi-structured interviews, they found a clear split in patient experiences. Some participants felt optimistic and ready to move forward, satisfied with their post-operative improvement. Others, however, expressed fear and uncertainty, worried about their symptoms coming back. The study also highlighted how much patients valued advice and guidance, but noted that the quality of this support could vary. Ultimately, the findings showed a wide range in patient needs both before and after their operation, suggesting that personalized rehabilitation could help capitalize on the positive physical and psychological changes that surgery can bring.

And for our final update, we stay with the topic of chronic neck pain to address the question: Could a behavioural physiotherapy approach improve recovery from chronic neck pain more than standard care? Research from a team including Alison Rushton explored this in a pilot clinical trial with 40 participants in Thailand. Half the group received an active behavioural physiotherapy intervention, while the other half received standard physiotherapy. The researchers measured outcomes like neck disability, pain levels, and fear-avoidance beliefs at the start of the study and again after three months. The findings showed that while both groups experienced some improvement, the participants receiving the behavioural approach had better outcomes on almost all measures. For instance, 75 percent of participants in the behavioural physiotherapy group were considered recovered based on their disability scores, compared with 35 percent in the standard care group.

And that concludes our updates for this week. A common element in today's topics—whether co-designing neck exercises, examining post-surgical outlooks, or applying behavioural physiotherapy—is the consideration of the patient's individual experience. The work suggests that recovery involves not only the physical condition but also a person's mindset, motivations, and fears.

Thank you for listening to Spinal Columns: Official Newsletter of CANSpine.