Effects of Physiotherapy Approaches on Biopsychosocial Outcomes in Chronic Non-Specific Neck Pain

Chronic non-specific neck pain (CNSNP) is a widespread musculoskeletal condition leading to pain, disability, and impaired quality of life. Due to its multifactorial nature involving biomechanical, sensorimotor, and psychosocial aspects, various rehabilitation interventions have been recommended. However, there is a lack of direct evidence comparing structured exercise, sensorimotor training, and pain neuroscience education within a comprehensive biopsychosocial framework. The primary objective of this randomized controlled trial is to evaluate and compare the effectiveness of structured exercise, sensorimotor training, and pain neuroscience education on disability, pain intensity, sensorimotor control, and psychosocial outcomes in individuals with CNSNP. Participants aged 18-65 with chronic non-specific neck pain will be randomly allocated into three intervention groups: Structured Exercise Group (SEG): Cervical stabilization, isometric/isotonic exercises, stretching, and range of motion training. Sensorimotor Training Group (SMTG): Cervical joint position sense retraining, oculomotor exercises, and balance training. Pain Neuroscience Education Group (PNEG): Online educational sessions focused on pain neurophysiology, central sensitization, and cognitive-behavioral strategies. Outcomes will be assessed at baseline (T0), completion of 8 weeks of intervention (T1), and 4 weeks post-intervention follow-up (T2, 12th week).

Inclusion Criteria: * Diagnosis of chronic non-specific neck pain lasting for more than 90 days * Age between 18 and 65 years (inclusive) * History of receiving standard physical therapy in a clinical setting in Turkey, yet experiencing persistent neck pain * Numeric Pain Rating Scale (NPRS) score ≥ 3/10 at rest and during active cervical movement * Neck Disability Index (NDI) score ≥ 5/50 * Voluntary agreement to participate and signing of the informed consent form Exclusion Criteria: * Neck pain associated with nerve root involvement or radiculopathy * History of prior cervical spine surgery * Physical therapy interventions received within the last 3 months * Severe spinal pathologies (e.g., fracture, tumor, infection, structural instability) * Systemic conditions (e.g., rheumatic, neurological, metabolic diseases) * Presence of vertigo or sensory loss * History of cancer within the last 5 years