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

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.

Inclusion criteria

• Age between 18-40 years of both male and female gender.
• Currently suffering from neck pain & bilateral neck pain for at least three months.
• Moderate pain intensity (30mm to 70mm) on Visual Analogue Scale .
• Access & knowledge of mobile phone and internet use .

Exclusion criteria

• Any previous neck surgery or cervical trauma .
• Fibromyalgia & Myelopathy .
• Spinal deformities like thoracic hyper kyphosis or scoliosis .
• Cervical radiculopathy ,vertigo, cancer & vertebral fractures.
• Infection or inflammatory arthritis in cervical spine .
• History of the whiplash injury .
• Physiotherapeutic treatment in the last six months .
• Cognitive disorder that prohibited the pain neuroscience education intervention from being followed .