BACKGROUND: Management of chronic mechanical neck pain (CMNP) still represents a challenge. A patient-oriented (Pa-O) therapeutic approach could be considered as the one in which therapies are scheduled at the start of each therapeutic session according to the patient's current physical status, and differs from a prescription-oriented (Pr-O) therapeutic approach, in which therapies are prescribed at the first medical referral and are not adjusted at any time during the treatment period. AIM: To determine if a Pa-O approach may be more beneficial for CMNP patients when compared to a Pr-O one. DESIGN: Randomized controlled trial. POPULATION: 220 CMNP outpatients randomized to either Pa-O group (n = 114) or Pr-O group (n = 106). METHODS: Each group received 10 therapeutic sessions over 3 weeks. Primary outcome measures were pain assessment, evaluated by visual-analog-scale (VAS), and disability level, evaluated by the Neck Pain and Disability Scale (NPDS-I). Secondary outcome measures included patients' response to treatment and treatment failures. Measurements were carried out at baseline (TO) and 1 month after treatment ended (Tl). Data were analysed according to the intention-to-treat principle. RESULTS: Patients in both groups displayed atTl a significant reduction in VAS and NPDS-I scores. The relative changes at Tl were greater in Pa-O group when compared with Pr-O group both for VAS (61.5% versus 48.8; p < 0.005) and for NPDS-I scores (48.4% versus 36.8; p < 0.05). CONCLUSION: A Pa-O approach may be more beneficial in terms of pain and disability improvement in the short-term follow-up in suffers from CMNP. However, the occurrence of a performance-bias due to the increased level of attention from physicians to patients in Pa-O group, cannot be ruled-out.

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