Effects of Clinical Based Versus Synchronized Telerehabilitation on Pain, Exercise Adherence, and Functional Disability Among Patients With Grade-II Cervical Spondylosis.

This randomized controlled trial aims to compare the effects of clinical-based rehabilitation and synchronized telerehabilitation on pain, exercise adherence, and functional disability in patients with Grade-II cervical spondylosis. A total of 52 participants will be randomly allocated into two parallel groups. Both groups will receive a standardized 6-week rehabilitation program, including cervical mobility exercises, strengthening, isometric exercises, stretching, and Mulligan self-mobilization techniques. The clinical group will receive in-person physiotherapy, while the telerehabilitation group will undergo real-time supervised sessions via video conferencing. Outcome measures will include pain (Numeric Pain Rating Scale), functional disability (Neck Disability Index), and exercise adherence (Exercise Adherence Rating Scale), assessed at baseline and post-intervention. The study aims to determine whether synchronized telerehabilitation is as effective as clinical-based rehabilitation and may provide a more accessible alternative for delivering physiotherapy care.

Study Overview

• Status: Not yet recruiting
• Conditions: Grade-II Cervical Spondylosis
• Intervention / Treatment: Other: Group A: Clinical Based Rehabilitation; Other: Group B: Synchronized Telerehabilitation

Detailed Description

Cervical spondylosis is a common degenerative condition of the cervical spine characterized by disc degeneration, osteophyte formation, and reduced cervical mobility, leading to neck pain and functional limitations. Grade-II cervical spondylosis represents a stage where patients are symptomatic but remain suitable for conservative management. Physiotherapy, particularly exercise-based rehabilitation, is widely used to improve pain, mobility, and functional capacity through strengthening, stretching, and neuromuscular re-education.

Clinical-based rehabilitation provides in-person physiotherapy with direct supervision, manual guidance, and real-time correction of exercises. However, access to such care is often limited due to barriers such as travel distance, cost, and time constraints. Synchronized telerehabilitation, delivered through real-time video conferencing, offers a potential alternative by enabling remote supervision, feedback, and patient engagement while maintaining continuity of care.

This randomized controlled trial aims to compare the effectiveness of clinical-based rehabilitation and synchronized telerehabilitation in patients with Grade-II cervical spondylosis. A total of 52 participants will be randomly assigned to two parallel groups. Both groups will receive a standardized 6-week rehabilitation program consisting of cervical range-of-motion exercises, deep cervical muscle strengthening, isometric exercises, stretching of the upper trapezius and levator scapulae, and Mulligan self-mobilization techniques (SNAGs). The clinical group will attend in-person sessions, while the telerehabilitation group will receive real-time supervised sessions via video conferencing.

Outcome measures include pain intensity assessed by the Numeric Pain Rating Scale (NPRS), functional disability measured by the Neck Disability Index (NDI), and exercise adherence evaluated using the Exercise Adherence Rating Scale (EARS), assessed at baseline and post-intervention.This study aims to determine whether synchronized telerehabilitation is comparable to clinical-based rehabilitation and may provide an accessible, cost-effective alternative for delivering physiotherapy care

• Study Type: Interventional
• Enrollment (Estimated): 52
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Shoaib Waqas; Phone Number: +923024552109; Email: shoaibwaqas@gmail.com

Study Locations

• Pakistan
  • Punjab Province
    • Lahore, Punjab Province, Pakistan, 54000
      • University of Biological and Applied Sciences

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Middle age adults (45-64) years
• Both gender ( male and female )
• Clinical daignosis of cervical spondylosis grade 2
• Mild to moderate pain on NPRS
• Sub acute stage ( 2-6 weeks) of grade 2 cervical spondylosis
• Able to follow instructions and give informed consent (cognitively able) Neurologically stable

Exclusion Criteria:

• Prior cervical spine surgery within the last 1 months or cervical instability.
• Inflammtory or systemic rheumatologic disease affecting the cervical spine (e.g., active rheumatoid arthritis ) or infection, tumor, fracture.
• Severe cardiopulmonary or other medical comorbidity that contraindicates exercise (unstable angina, uncontriolled hypertension, recent MI)
• Severe hearing or visual impairment
• No smoking and daibetic history

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Group A: Clinical Based Rehabilitation; Participants in Group A will receive clinical-based rehabilitation through in-person physiotherapy sessions in an outpatient setting. Treatment will be delivered three times per week for 6 weeks, with each session lasting approximately 30-40 minutes. All interventions will be provided under the direct supervision of a qualified physiotherapist, ensuring proper monitoring, guidance, and correction of patient performance during therapy sessions. Participants will also receive standardized instructions for home-based continuation of care on non-supervised days to support consistency of rehabilitation. The focus of this arm is to evaluate the effectiveness of traditional face-to-face physiotherapy care in improving pain, functional disability, and exercise-related outcomes in patients with Grade-II cervical spondylosis.	Other: Group A: Clinical Based Rehabilitation; The first intervention is clinical-based rehabilitation, delivered through in-person physiotherapy sessions in an outpatient clinical setting. Participants will receive supervised treatment three times per week for 6 weeks, with each session lasting approximately 30-40 minutes. All sessions will be conducted by a qualified physiotherapist who will provide direct monitoring, guidance, and correction to ensure proper execution of therapy. This conventional rehabilitation approach emphasizes face-to-face interaction, allowing individualized attention and real-time clinical decision-making. Participants will also be advised to continue prescribed home-based activities on non-session days to maintain consistency and support recovery outcomes.
Active Comparator: Group B: Synchronized Telerehabilitation; Participants in Group B will receive synchronized telerehabilitation delivered through real-time video conferencing. Sessions will be conducted three times per week for 6 weeks, with each session lasting approximately 30-40 minutes. Rehabilitation will be supervised live by a qualified physiotherapist who will provide instruction, monitoring, and feedback during each session to ensure correct performance and safety. This remote delivery model will replicate the structure of clinical-based rehabilitation while eliminating the need for in-person visits. Participants will also be given standardized guidance for continuing home-based activities on non-session days. This arm aims to evaluate the effectiveness of synchronized telehealth-based physiotherapy in improving pain, functional disability, and exercise adherence in patients with Grade-II cervical spondylosis.	Other: Group B: Synchronized Telerehabilitation; The second intervention is synchronized telerehabilitation, delivered through real-time video conferencing sessions. Participants will receive supervised physiotherapy remotely three times per week for 6 weeks, with each session lasting approximately 30-40 minutes. A qualified physiotherapist will provide live instruction, monitoring, and feedback to ensure correct performance and safety during exercises. This approach replicates the structure of clinical-based rehabilitation while eliminating the need for in-person visits. Participants will also be given standardized home-based activity instructions for non-session days to maintain continuity of care. The intervention aims to evaluate the effectiveness of remote, technology-based rehabilitation in improving clinical outcomes in patients with Grade-II cervical spondylosis.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Pain Intensity	Pain intensity will be assessed using the Numeric Pain Rating Scale (NPRS), an 11-point scale ranging from 0 (no pain) to 10 (worst imaginable pain). Participants will rate their average neck pain over the past 24 hours. The NPRS is a valid and reliable tool widely used in musculoskeletal conditions, including cervical spondylosis, to measure changes in pain severity.	Measured at baseline (pre-intervention) and after 6 weeks (post-intervention completion).
Functional Disability	Functional disability will be assessed using the Neck Disability Index (NDI), a validated questionnaire designed to measure the impact of neck pain on daily activities. It includes domains such as pain intensity, personal care, lifting, reading, work, concentration, sleep, and recreation. Each item is scored, with higher total scores indicating greater disability. The NDI is widely used in cervical spine disorders due to its strong reliability, validity, and sensitivity to clinical change.	Measured at baseline (pre-intervention) and at 6 weeks post-intervention completion.
Exercise Adherence	Exercise adherence will be assessed using the Exercise Adherence Rating Scale (EARS), a validated self-reported questionnaire designed to measure the extent to which patients comply with prescribed home exercise programs. It evaluates behaviors such as frequency of exercise performance, consistency in following instructions, and patient commitment to rehabilitation. The scale provides insight into adherence patterns that directly influence treatment effectiveness in musculoskeletal conditions. Higher scores indicate better adherence to the prescribed exercise regimen. The EARS is widely used in rehabilitation research due to its good reliability and internal consistency.	Measured at baseline and at 6 weeks post-intervention completion.

Collaborators and Investigators

• Sponsor: Lahore University of Biological and Applied Sciences

Study record dates

Study Major Dates

• Study Start (Estimated): July 1, 2026
• Primary Completion (Estimated): October 1, 2026
• Study Completion (Estimated): November 30, 2026

Study Registration Dates

• First Submitted: June 25, 2026
• First Submitted That Met QC Criteria: June 25, 2026
• First Posted (Actual): July 1, 2026

Study Record Updates

• Last Update Posted (Actual): July 1, 2026
• Last Update Submitted That Met QC Criteria: June 25, 2026
• Last Verified: May 1, 2026

More Information

Terms related to this study

• Keywords: Pain; Telerehabilitation; Cervical Spondylosis; Functional Disability; Excercise Adherence
• Additional Relevant MeSH Terms: Neurologic Manifestations; Bone Diseases; Musculoskeletal Diseases; Spinal Diseases; Pathological Conditions, Signs and Symptoms; Signs and Symptoms; Pain; Spondylosis
• Other Study ID Numbers: UBAS/ERB/26/04/034

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: baseline participants
• IPD Sharing Supporting Information Type: STUDY_PROTOCOL; SAP; ICF; CSR

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No