BACKGROUND: Active physiotherapy utilizes patient-centered, sensorimotor-integrated interventions to modulate central nervous system function. This randomized controlled trial (RCT) compared the efficacy of multimodal active physiotherapy (MAP) versus multimodal passive physiotherapy (MPP) in improving physical and mental health in chronic nonspecific neck pain (CNNP) patients. METHODS: This single-blind, stratified parallel-group RCT included 54 patients with CNNP. Participants were randomly assigned to the MAP or MPP group, both receiving 16 treatment sessions (60 min/session) over 8 weeks. Primary outcomes were pain intensity (Numeric Pain Rating Scale) and emotional status (Hospital Anxiety and Depression Scale). Secondary outcomes included patient-perceived change, pain modulation, insomnia symptoms, kinesiophobia, neck function, and mental health-related quality of life (QoL). Intention-to-treat analyses were performed. RESULTS: Postintervention, there were no significant group-time interactions in the primary outcomes (pain intensity, anxiety, and depression; all p > 0.05), despite significant within-group improvements from baseline (all p < 0.01). Analyses adjusted for covariates confirmed no between-group differences. For secondary outcomes, the MAP group demonstrated superior improvements compared to the MPP group in conditioned pain modulation, kinesiophobia, and mental health-related QoL; no other significant differences were observed between the groups. CONCLUSION: In patients with CNNP, MAP and MPP result in comparable improvements in pain and emotional status; however, MAP demonstrates superior benefits relative to MPP in pain modulation, movement-related fear, and mental health-related QoL. TRIAL REGISTRATION: Chinese Registry of Clinical Trials: ChiCTR2500104619.

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