- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT05321654
Effects of Postural Education or Corrective Exercise on Forward Head Posture
The Effects of Postural Education or Corrective Exercise Intervention on the Craniovertebral Angle in Young Adults With Forward Head Posture: A Randomized Controlled Trial
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
A total of 94 participants responded to invitations to voluntarily participate and completed the Physical Activity Readiness Questionnaire (PAR-Q+), followed by a questionnaire to rate their current stage of change (SOC) from the Transtheoretical Model adapted to assess exercise/postural modification behavior change (this will be discussed further in eligibility section). On this questionnaire, participants also responded to a yes/no question regarding if they have had a recent injury to their head, shoulders, or spine; or have ever been diagnosed with a pathology related to their cervical/thoracic spine or extremities, as part of exclusion criteria for the study. Participants then underwent a head posture screening performed by the primary investigator who is a licensed physical therapist in the Liberty University Biomechanics & Motion Analysis Laboratory with the use of photogrammetry (use of a digital camera and software to measure posture) as described below.
Participants were asked to arrive at the lab wearing either a tank top or t-shirt, as well as to have their hair tied back if necessary. Height and weight were measured using a digital scale (Health-o-meter Professional, model 500KL, McCook, IL). Participants were instructed to sit comfortably on a stool with hands resting approximately two-thirds down their thighs with palms supinated and feet flat on the ground with hips and knees at 90 degrees; and to look straight ahead at an opposite wall in the laboratory. A digital camera (Canon Powershot, model SX540, Tokyo, Japan) was mounted and leveled on a tripod (Manfrotto, model 055, Cassola, IT) and placed three meters away from the subject. Two photographs were taken of participant's posture. Immediately after data capture, image files were uploaded into Kinovea video analysis software (version 8.15) for CVA assessment. CVA assessment will be discussed further in outcome measures section.
Seventy-nine participants met inclusion criteria (discussed in detail in future section) and were enrolled in the study. Randomization of participant group assignments was completed by the PI using a block randomization generator. Utilizing a sequence created by the block randomizer, the PI placed participants who met inclusion criteria into one of four groups: postural education (PE; n = 20), self-myofascial release + stretching (SMRS; n = 20), self-myofascial release + stretching + strengthening (SMRSS; n = 19), and control group (CG; n = 20). Details of these groups will be provided in future sections. A hard-copy of the sequence generator report was kept concealed in a manila folder and was only opened by the PI during group delegation.
Intervention duration was 4 weeks. Two weeks into the study, participants in intervention groups completed a mid-study questionnaire to assess intervention compliance. At the end of the study (after the completion of 4 weeks) participants in intervention groups completed a post-study questionnaire to assess intervention compliance. All study participants were asked to return back to the Biomechanics laboratory after the completion of the 4 week intervention period to undergo follow-up posture screening, which followed the same posture assessment procedures as described above.
Declarations of interest: This study was part of the requirements for completion of a Ph.D. dissertation (Concordia University Chicago) by David Titcomb, DPT.
Conflicts of interest: none.
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Locations
-
-
Virginia
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Lynchburg, Virginia, United States, 24515
- Liberty University
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-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Completion of informed consent
- Craniovertebral angle ≤ 53 degrees
- Self-rating of Transtheoretical Model stage of change stage ≥ 3/5
Exclusion Criteria:
- Any musculoskeletal injury to the head, shoulders, or spine within the last six months
- Diagnosis of pathology related to the cervical spine, thoracic spine, or upper extremities
- Non-clearance for physical activity based on results of the 2020 PAR-Q+ questionnaire
Study Plan
How is the study designed?
Design Details
- Primary Purpose: PREVENTION
- Allocation: RANDOMIZED
- Interventional Model: PARALLEL
- Masking: NONE
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
EXPERIMENTAL: Posture Education (PE) Group
PE group members received a 20-minute in-person one-on-one standardized educational session by a research team member in the laboratory on the following topics: health risks associated with forward head posture; postural guidelines for using mobile electronic devices, desktop computers, and laptop computers; as well as rest break guidelines.
Participants were asked to adhere to the postural guidelines provided in the educational session for the next 4 weeks.
|
Please see arm description for a detailed description of the intervention
|
EXPERIMENTAL: Self-Myofascial Release + Stretching (SMRS) Group
This group applied self-myofascial release (SMR) to their thoracic spine with a myofascial roller for 30 sec., then 6 repetitions of myofascial rolling for 90 sec.
They applied SMR for 30 sec. to their neck flexors and extensors using their fingertips.
They applied SMR to the upper trapezius and pectoralis for 30 sec using a soft tissue mobilization tool.
For the first 2 weeks, they performed SMR 3x/wk.
During wks. 3 and 4, they progressed SMR to 5 days/wk.
Group members also performed stretching to these same muscles after SMR 3 days/wk for the first 2 weeks of the study, progressing to 5 days/wk during weeks 3 and 4.
|
Please see arm description for a detailed description of the intervention
|
EXPERIMENTAL: Self-Myofascial Release + Stretching + Strengthening (SMRSS) Group
This group performed the same protocol as SMRS group, as well as include the following strengthening exercises: the supine chin tuck (SCT), upper thoracic-lower cervical extension (UTLCE) using an exercise band that provided 5.5 pounds of resistance, and a single-arm row with trunk rotation (SARTR) using exercise tubing that provided 20 pounds of resistance.
The SCT was progressed in 3 phases: Week 1: chin tuck held 2 sec., 5 reps.
Week 2: same as week 1, but included us of a towel roll placed under the head.
Wks. 3 and 4: chin tuck with head lift 1 in., 2 sec.
hold.
UTLCE: neck extension with exercise band, held 2 sec.
SARTR: single arm row with trunk rotation was performed in a controlled and fluid manner using a self-selected speed.
The UTLCE and SARTR were performed with 1 X 10 reps for wks 1-2 and progressed to 2 X10 reps in wks 3-4.
Strengthening exercises were performed 3x/wk.
for 4 wks.
|
Please see arm description for a detailed description of the intervention
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NO_INTERVENTION: Control Group (CG)
Participants in the CG did not receive an intervention.
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Change in Craniovertebral Angle after 4 weeks
Time Frame: Baseline: On day 1 of study enrollment; Post-Intervention: Within 5 days after the end of the 4 week intervention period
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The angle between the intersection of two lines drawn on the photograph: the first line drawn from the tragus of the ear to the spinous process of C7 vertebrae and the second line drawn horizontally through C7 spinous process.
In this study, a second researcher directly observed the primary investigator performing each CVA assessment, as well as provided verbal agreement with the accuracy of angle measurement.
For each participant, the CVA was derived by taking the mean of two CVA measurements that were assessed on the captured photographs.
|
Baseline: On day 1 of study enrollment; Post-Intervention: Within 5 days after the end of the 4 week intervention period
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Midpoint Intervention Compliance
Time Frame: Assessed at the start of week 3
|
On a questionnaire, participants were asked to rate their compliance with their assigned intervention guidelines.
Consistent.
75% adherence to guidelines; Moderately Consistent.
50 to 75% adherence to guidelines; Inconsistent.
Less than 50% adherence to guidelines.
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Assessed at the start of week 3
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Endpoint Intervention Compliance
Time Frame: Within 5 days after the end of the 4 week intervention period.
|
On a questionnaire, participants were asked to rate their compliance with their assigned intervention guidelines.
Consistent.
75% adherence to guidelines; Moderately Consistent.
50 to 75% adherence to guidelines; Inconsistent.
Less than 50% adherence to guidelines.
|
Within 5 days after the end of the 4 week intervention period.
|
Collaborators and Investigators
Sponsor
Collaborators
Investigators
- Principal Investigator: David A Titcomb, DPT, Liberty University
- Study Chair: Bridget F Melton, EdD, Concordia University Chicago
- Study Director: Theresa Miyashita, PhD, Concordia University Chicago
- Study Director: Helen W Bland, PhD, Concordia University Chicago
Publications and helpful links
General Publications
- Lee DY, Nam CW, Sung YB, Kim K, Lee HY. Changes in rounded shoulder posture and forward head posture according to exercise methods. J Phys Ther Sci. 2017 Oct;29(10):1824-1827. doi: 10.1589/jpts.29.1824. Epub 2017 Oct 21.
- Kim SY, Koo SJ. Effect of duration of smartphone use on muscle fatigue and pain caused by forward head posture in adults. J Phys Ther Sci. 2016 Jun;28(6):1669-72. doi: 10.1589/jpts.28.1669. Epub 2016 Jun 28.
- Ruivo RM, Pezarat-Correia P, Carita AI. Cervical and shoulder postural assessment of adolescents between 15 and 17 years old and association with upper quadrant pain. Braz J Phys Ther. 2014 Jul-Aug;18(4):364-71. doi: 10.1590/bjpt-rbf.2014.0027. Epub 2014 Jul 18.
- Abdelhameed AA, Abdel-Aziem AA. Exercise training and postural correction improve upper extremity symptoms among touchscreen smartphone users. Hong Kong Physiother J. 2016 Sep 7;35:37-44. doi: 10.1016/j.hkpj.2016.06.001. eCollection 2016 Dec.
- Bayattork M, Seidi F, Minoonejad H, McClure P, Mozafaripoor E. Intra-rater and inter-rater reliability and agreement of the scapular dyskinesis test in young men with forward head and round shoulder posture. J Rehabil. Sci. 2019 Dec 10;6(4):169-173. https://doi.org/10.30476/JRSR.2019.82944.1037
- Carter SE, Draijer R, Holder SM, Brown L, Thijssen DHJ, Hopkins ND. Regular walking breaks prevent the decline in cerebral blood flow associated with prolonged sitting. J Appl Physiol (1985). 2018 Sep 1;125(3):790-798. doi: 10.1152/japplphysiol.00310.2018. Epub 2018 Jun 7.
- Cuellar JM, Lanman TH. "Text neck": an epidemic of the modern era of cell phones? Spine J. 2017 Jun;17(6):901-902. doi: 10.1016/j.spinee.2017.03.009. Epub 2017 Mar 20. No abstract available.
- Engelmann C, Schneider M, Kirschbaum C, Grote G, Dingemann J, Schoof S, Ure BM. Effects of intraoperative breaks on mental and somatic operator fatigue: a randomized clinical trial. Surg Endosc. 2011 Apr;25(4):1245-50. doi: 10.1007/s00464-010-1350-1. Epub 2010 Sep 11.
- Fahmy R. NASM Essentials of corrective exercise training. 2nd ed. Burlington, Massachusetts: Jones & Bartlett Learning; 2022.
- Gustafsson E. Ergonomic recommendations when texting on mobile phones. Work. 2012;41 Suppl 1:5705-6. doi: 10.3233/WOR-2012-0925-5705.
- Hansraj KK. Assessment of stresses in the cervical spine caused by posture and position of the head. Surg Technol Int. 2014 Nov;25:277-9.
- Kalichman L, Bulanov N, Friedman A. Effect of exams period on prevalence of Myofascial Trigger points and head posture in undergraduate students: Repeated measurements study. J Bodyw Mov Ther. 2017 Jan;21(1):11-18. doi: 10.1016/j.jbmt.2016.04.003. Epub 2016 Apr 7.
- Kar G, Hedge A. Effect of workstation configuration on musculoskeletal discomfort, productivity, postural risks, and perceived fatigue in a sit-stand-walk intervention for computer-based work. Appl Ergon. 2021 Jan;90:103211. doi: 10.1016/j.apergo.2020.103211. Epub 2020 Aug 17.
- Kim BB, Lee JH, Jeong HJ, Cynn HS. Effects of suboccipital release with craniocervical flexion exercise on craniocervical alignment and extrinsic cervical muscle activity in subjects with forward head posture. J Electromyogr Kinesiol. 2016 Oct;30:31-7. doi: 10.1016/j.jelekin.2016.05.007. Epub 2016 May 24.
- Kuroda Y, Sato Y, Ishizaka Y, Yamakado M, Yamaguchi N. Exercise motivation, self-efficacy, and enjoyment as indicators of adult exercise behavior among the transtheoretical model stages. Glob Health Promot. 2012 Mar;19(1):14-22. doi: 10.1177/1757975911423073. Epub 2012 Feb 14.
- Lau KT, Cheung KY, Chan KB, Chan MH, Lo KY, Chiu TT. Relationships between sagittal postures of thoracic and cervical spine, presence of neck pain, neck pain severity and disability. Man Ther. 2010 Oct;15(5):457-62. doi: 10.1016/j.math.2010.03.009.
- Neupane S, Ali UI, Mathew A. Text neck syndrome-systematic review. Imp. J. Interdiscip. Res. 2017; 3(7): 141-148. http://www.onlinejournal.in
- Richards KV, Beales DJ, Smith AJ, O'Sullivan PB, Straker LM. Neck Posture Clusters and Their Association With Biopsychosocial Factors and Neck Pain in Australian Adolescents. Phys Ther. 2016 Oct;96(10):1576-1587. doi: 10.2522/ptj.20150660. Epub 2016 May 12.
- Sahu M, Sundari KG, David A. Recent ergonomic interventions and evaluations on laptop, smartphones and desktop computer users. In Arockiarajan A, Duraiselvam M, Raju R, editors. Advances in Industrial Automation and Smart Manufacturing. Singapore: Springer; 2021. p. 207-224. https://doi.org/10.1007/978-981-15-4739-3
- Syamala KR, Ailneni RC, Kim JH, Hwang J. Armrests and back support reduced biomechanical loading in the neck and upper extremities during mobile phone use. Appl Ergon. 2018 Nov;73:48-54. doi: 10.1016/j.apergo.2018.06.003. Epub 2018 Jun 18.
- Vate-U-Lan P. Text neck epidemic: a growing problem for smart phone users in Thailand. Int J Comput. Internet Manage. 2015 Sept-Dec;23(3): 551-556.
- Warburton DER, Jamnik VK, Bredin SSD, and Gledhill N. The physical activity readiness questionnaire for everyone (PAR-Q+) and electronic physical activity readiness medical examination (ePARmed-X+). Health Fit J of Canada. 2011; 4(2):3-23. https://doi.org/10.14288/hfjc.v4i2.103
Study record dates
Study Major Dates
Study Start (ACTUAL)
Primary Completion (ACTUAL)
Study Completion (ACTUAL)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (ACTUAL)
Study Record Updates
Last Update Posted (ACTUAL)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Other Study ID Numbers
- IRB-FY20-21-1073
- UR2201 (OTHER_GRANT: Liberty University Center for Research & Scholarship)
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
IPD Plan Description
IPD Sharing Time Frame
IPD Sharing Access Criteria
IPD Sharing Supporting Information Type
- STUDY_PROTOCOL
- SAP
- ICF
- ANALYTIC_CODE
- CSR
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
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