Relationship of Forward Head Posture With Burnout and Quality of Life

Relationship of Forward Head Posture With Burnout and Quality of Life in Patients With Mechanical Neck Pain

The goal of this observational study is to investigate the relationship of forward head posture with burnout and quality of life in patients with mechanical neck pain.

The main questions the study aims to answer are:

Is there a significant correlation between the severity of forward head posture (measured by Kinovea software) and psychological burnout (evaluated by the Maslach Burnout Inventory, MBI)?

How do different degrees of forward head posture impact pain intensity, pressure pain threshold, cervical proprioception, and cognitive function (assessed via CogniFit application)?

comparison groups:

Researchers will compare different degrees of forward head posture to see if varying degrees of forward head posture lead to different levels of physical, cognitive, and psychological impairments.

Participants will:

Undergo posture assessment using Kinovea software to determine their forward head posture angle and be allocated into their respective study groups.

pain intensity and pressure pain threshold measured using the Visual Analogue Scale (VAS) and pressure algometry.

Perform a cervical proprioception test using a pointer laser device.

Complete cognitive evaluations using the Montreal Cognitive Assessment (MoCA) and the CogniFit digital application.

Fill out standardized questionnaire, the Maslach Burnout Inventory (MBI) ,to assess burnout .

quality of life will be measured using Arabic- WHOQOL-BREF

Study Overview

• Status: Not yet recruiting
• Conditions: Forward Head Posture
• Intervention / Treatment: Other: postural, physical, and cognitive assessment

Detailed Description

Background and Rationale:

Mechanical neck pain is a widespread musculoskeletal disorder frequently linked to postural abnormalities, most notably Forward Head Posture (FHP). Prolonged exposure to poor ergonomic habits and forward head alignment creates continuous biomechanical stress on the cervical spine's musculature and joints. Beyond physical pain and restricted mobility, chronic musculoskeletal discomfort can exert significant strain on the central nervous system, sensorimotor control, and psychological well-being, potentially triggering burnout and diminishing the overall quality of life.

Study Design and Group Allocation:

This observational/cross-sectional (or comparative) study is designed to evaluate and correlate the degree of forward head posture with psychological burnout and quality of life parameters among patients with mechanical neck pain. Participants diagnosed with mechanical neck pain and exhibiting forward head posture will be assessed using the Kinovea software to measure the craniovertebral angle (CVA) .

Outcome Measures and Assessment Protocols:

To comprehensively examine the physiological, sensorimotor, cognitive, and psychological impacts across participant, a battery of standardized and objective evaluation tools will be administered:

Pain Assessment and Pressure Pain Threshold:

Pain intensity will be quantified using the Visual Analogue Scale (VAS). Pressure pain thresholds over cervical and upper quarter trigger points will be evaluated using pressure algometry.

Cervical Proprioception:

Cervical position sense and repositioning accuracy will be measured using a pointer laser device attached to the participant's head, assessing joint position error.

Cognitive Function:

Global cognitive screening will be performed using the Montreal Cognitive Assessment (MoCA).

Detailed, computerized cognitive domains will be assessed via the CogniFit digital application.

Burnout:

Psychological burnout will be thoroughly evaluated using the Maslach Burnout Inventory (MBI), addressing dimensions such as emotional exhaustion, depersonalization, and reduced personal accomplishment.

Quality of life:

The Arabic version of the WHOQOL-BREF will be used to assess health-related quality of life among patients with mechanical neck pain. It evaluates four domains: physical health, psychological health, social relationships, and environment, allowing assessment of the relationship between forward head posture and quality of life.

Clinical Significance:

By assessing forward head posture using precise Kinovea-derived craniovertebral angle measurements and examining its relationship with multidimensional outcomes (pain, proprioception, and MBI-measured burnout), alongside quality of life, this study aims to clarify the potential impact of forward head posture on the physical and psychological well-being of patients with mechanical neck pain. The findings may contribute to a better understanding of these relationships and help guide physical therapy assessment and rehabilitation strategies.

• Study Type: Observational
• Enrollment (Estimated): 50

Contacts and Locations

• Study Contact: Name: Ahmed Mossaed, Demonstrator/ M.Sc. researcher; Phone Number: 00201069062868; Email: amosaed79@gmail.com
• Study Contact Backup: Name: Marwa Mostafa abdel moneim, lecturer of physical therapy; Phone Number: 00201005661591; Email: marwa.mostafa@cu.edu.eg

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 35 years to 50 years (Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

• Sampling Method: Non-Probability Sample

Study Population

A total of 50 patients of both sexes (aged 35-50 years) with mild to moderate mechanical neck pain and forward head posture will be recruited from the outpatient clinic of the Faculty of Physical Therapy, Cairo University, following diagnosis and referral by a neurologist.

Eligibility Criteria:

Age between 35 and 50 years. Mild to moderate mechanical neck pain (assessed by VAS) with symptom duration from 6 months up to 2 years.

Cooperative patients with sufficient cognitive abilities to understand and follow instructions.

Group Allocation:

Based on the Craniovertebral Angle (CVA) measured via Kinovea software, participants will be divided into two groups:

Group 1: CVA between 40° and 45°. Group 2: CVA between 45° and 50°.

Ethical Consideration:

All participants will sign an informed consent form after receiving full details regarding study purpose, procedures, benefits, data privacy, and their right to withdraw

Description

Inclusion Criteria:

• 50 patients of both sexes diagnosed with mild to moderate mechanical neck pain with forward head.
• Patient's age 35-50 years
• Patients with mild to moderate mechanical neck pain by VAS
• Duration of symptoms will be more than 6 months up to 2 years
• Co-operative patients with sufficient cognitive abilities that enables them to understand and follow instructions
• MOCA score equal to or more than 26

Exclusion Criteria:

• Any neurological disease that causes mechanical neck pain rather than forward head posture, especially radiculopathy.
• Depressed patients
• History of cervical surgery , trauma or Severe neurological deficits (e.g., motor paralysis
• Sever mechanical neck pain
• Patients with visual or auditory impairment affecting their ability to complete the testing
• Patients with cognitive impairment

Study Plan

How is the study designed?

Design Details

• Observational Models: OTHER
• Time Perspectives: CROSS_SECTIONAL

Number of groups / cohorts

1

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
forward head posture group 1; patients with mechanical neck pain who have forward head posture angle ranging from 40:50 degrees measured by kinovea software	Other: postural, physical, and cognitive assessment; no therapeutic intervention is provided. Participants only undergo postural evaluation (Kinovea), pain assessment (VAS and Algometry), proprioception testing, and cognitive/psychological evaluations (MoCA, CogniFit, and MBI).

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Craniovertebral Angle (CVA) Measured Using Kinovea Software	Forward head posture will be assessed using digital lateral photographs analyzed with Kinovea software. The craniovertebral angle (CVA) will be measured in degrees using the angle formed between the horizontal line passing through the C7 spinous process and the line connecting C7 to the tragus. Lower CVA values indicate greater forward head posture.	Baseline (at the initial assessment)

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
pain intensity assessed using visual analog scale.	Pain intensity will be assessed using the Visual Analog Scale (VAS), a 10-cm horizontal line anchored by "no pain" (0 cm) at one end and "worst imaginable pain" (10 cm) at the other end. Participants will be instructed to mark the point on the line that best represents their current neck pain intensity. The score will be determined by measuring the distance from the "no pain" anchor to the participant's mark. The minimum value is 0, indicating no pain, and the maximum value is 10, indicating the worst imaginable pain. Higher scores indicate greater pain intensity and worse outcomes, whereas lower scores indicate lower pain intensity and better outcomes	Baseline (at the initial assessment)
neck proprioception assessed using joint position error test	Cervical proprioception will be assessed using the Joint Position Error (JPE) test with a laser pointer. Participants will be instructed to perform active cervical movements with their eyes closed and return their head to the initial neutral position. The distance between the laser pointer's final position and the original target position will be measured in centimeters (cm). The minimum value is 0 cm, indicating no repositioning error. Lower scores indicate better cervical proprioceptive accuracy, whereas higher scores indicate greater repositioning error and poorer cervical proprioception.	Baseline (at the initial assessment)
cognition (cognitive function) assessed using cognifit application	CogniFit is a computerized cognitive assessment platform used to evaluate multiple cognitive abilities, including attention, memory, reasoning, and other cognitive functions. Each cognitive ability is assessed separately, and scores are generated according to the platform's scoring system. Each score ranges from 0 to 800 points, where 0 represents the minimum score and 800 represents the maximum score. Higher scores indicate better cognitive performance, whereas lower scores indicate poorer cognitive performance.	Baseline (at the initial assessment)
pressure pain threshold assessed using pressure algometry.	Pressure pain threshold (PPT) will be assessed using a pressure algometer applied over the C6 and C7 cervical vertebral levels and the surrounding cervical soft tissues at predetermined assessment sites. The algometer probe will be applied perpendicularly to the skin, and pressure will be gradually increased at a constant rate until the participant first perceives the pressure as painful. The force at the onset of pain will be recorded in kilograms (kg). Three measurements will be performed at each assessment site, with 30-second intervals between trials, and the mean value will be calculated for analysis. The minimum value is 0 kg, while the maximum value depends on the measurement capacity of the algometer. Higher values indicate a higher pressure pain threshold and lower pressure sensitivity, representing better outcomes, whereas lower values indicate greater pressure sensitivity and worse outcomes.	Baseline (at the initial assessment)
Burnout Measured Using the Maslach Burnout Inventory	Burnout will be assessed using the Arabic version of the Maslach Burnout Inventory (MBI-MR). The questionnaire evaluates burnout-related dimensions, including emotional exhaustion, depersonalization, and personal accomplishment. Scores will be calculated according to the scoring instructions of the instrument, with higher scores indicating greater burnout in the relevant burnout dimensions.	Baseline (at the initial assessment)
Quality of Life Measured Using the Arabic Version of WHOQOL-BREF	Quality of life will be assessed using the Arabic version of the World Health Organization Quality of Life-BREF (WHOQOL-BREF). The questionnaire evaluates four domains: physical health, psychological health, social relationships, and environment. Domain scores will be calculated according to the instrument's scoring guidelines and transformed to a scale ranging from 0 to 100, with higher scores indicating better quality of life.	Baseline (at the initial assessment)

Collaborators and Investigators

• Sponsor: Cairo University

Study record dates

Study Major Dates

• Study Start (Estimated): November 20, 2026
• Primary Completion (Estimated): February 20, 2027
• Study Completion (Estimated): March 1, 2027

Study Registration Dates

• First Submitted: October 8, 2026
• First Submitted That Met QC Criteria: October 16, 2026
• First Posted (Actual): October 23, 2026

Study Record Updates

• Last Update Posted (Actual): November 4, 2026
• Last Update Submitted That Met QC Criteria: November 1, 2026
• Last Verified: October 1, 2026

More Information

Terms related to this study

• Keywords: quality of life; cognition; forward head posture; burnout; mechanical neck pain; neck proprioception
• Additional Relevant MeSH Terms: Behavioral Symptoms; Stress, Psychological; Behavior; Burnout, Psychological; Investigative Techniques; Therapeutics; Behavior Control; Immobilization; Restraint, Physical
• Other Study ID Numbers: P.T.REC/012/006565

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

IPD Plan Description

Data is available with corresponding author on reasonable request

Drug and device information, study documents

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