Relationship of Forward Head Posture With Burnout and Quality of Life

patients with mechanical neck pain who have forward head posture angle ranging from 40:50 degrees measured by kinovea software

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).

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.

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

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.

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.

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.

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.

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.