Health guidelines recommend neck exercises as a primary treatment for long-term neck pain that does not have a specific known cause. However, current exercise programs often have limited success, and many patients find it difficult to stick with them. The goal of this study was to design a new neck exercise program, working directly with patients, to make it more effective and easier to follow.

Researchers used a structured, four-step design process called "Intervention Mapping" and collaborated with a group of 17 patients. In the first step, they identified the specific improvements the program should aim for, such as less pain or better sleep, by reviewing existing research and holding workshops with the patients.

To make the program more effective, the researchers identified the specific goals of the exercises and how they work to improve neck pain, based on scientific reviews and expert agreement. They then selected the most effective exercises and developed strategies for tailoring them to each individual. To help patients stick to the program, the researchers identified the key actions patients needed to take and the factors that could help or hinder them from performing those actions. Based on this, they chose specific techniques to help patients overcome challenges and stay motivated. In the final step, they created resources with patients and physiotherapists to support the program's use in a clinical setting.

The new program, called the EPIC-Neck program, is designed to be personalized to each patient. It aims to improve outcomes like pain, disability, daily function, sleep, mental well-being, and the effect of pain on relationships. The program uses a broad approach to prescribing exercise that considers biological, psychological, and social factors. Exercises are customized to improve muscle and nerve function, increase a person's confidence in managing their pain, reduce pain at night, and improve mental focus. The program also aims to reduce unhelpful thought patterns, like expecting the worst or avoiding movement out of fear, while also building social support.

For patients to manage their neck pain successfully with this program, they are guided to do four key things: perform specific neck exercises, learn to adjust and progress these exercises on their own, use the exercises during pain flare-ups, and start doing general exercise. A guide was also developed for therapists to help patients stick with the plan. This guide addresses 35 different factors that influence behavior by using 24 techniques, such as goal setting, increasing motivation, planning actions, self-monitoring, problem-solving, shared decision-making, and patient-focused communication.

In conclusion, this study produced an exercise program that was co-developed with patients and is based on scientific evidence and theories of behavior change. It was designed to improve both treatment effectiveness and patient participation. Future research will test how practical and acceptable the program is for patients and physiotherapists. In the long term, studies will also be needed to determine its health benefits and cost-effectiveness.