Barriers to adhering to a pain neuroscience education and therapeutic exercise programme in people with chronic neck pain: A mixed-methods study.

ObjectiveTo identify perceived barriers to adhering to a group-based programme combining pain neuroscience education and therapeutic exercise among people with chronic neck pain, and to assess the perceived relative importance and frequency of such barriers according to sociodemographic factors and programme attendance.DesignMixed-methods study using a concept mapping approach.SettingTwo primary care centres in Catalonia (Spain).ParticipantsSixty-three individuals with chronic neck pain.InterventionParticipation in a group-based pain neuroscience education and therapeutic exercise programme.Main measuresPerceived barriers to adhering to a combined pain neuroscience education and therapeutic exercise programme were generated, sorted, and rated by participants according to importance and frequency scores (5-point Likert scale). Cluster maps and go-zone plots were derived using multidimensional scaling and hierarchical cluster analysis. Exploratory subgroup analyses were conducted.ResultsThirty-two statements were grouped into four clusters: Adequacy and adaptation, Organisation and format, Information and educational support, and Therapeutic relationship. Adequacy and adaptation showed the highest ratings for importance and frequency, followed by Information and educational support, and Therapeutic relationship; Organisation and format showed the lowest. Exploratory analyses indicated higher ratings for barriers related to organisational and information-related aspects among younger participants, and for understanding-related difficulties among participants with <70% programme attendance.ConclusionsPerceived barriers to adherence appear to be structured around three interrelated domains: programme adequacy and adaptation, information and educational support, and therapeutic relationship. Organisational and information-related barriers were perceived as more relevant among younger participants, whereas understanding-related difficulties were more relevant among participants with <70% programme attendance.