EFFECTS OF PROPRIOCEPTIVE NEUROMUSCULAR FACILITATION COMBINED WITH REAL-TIME SMARTPHONE ERGONOMIC MONITORING ON PAIN, CERVICAL RANGE OF MOTION, DISABILITY, AND FORWARD HEAD POSTURE IN PHYSIOTHERAPISTS WITH TEXT NECK SYNDROME: A RANDOMIZED CONTROLLED TRIAL

Abstract

Text Neck Syndrome (TNS) results from sustained postural asymmetry due to the use of handheld devices. Physiotherapists are at an increased risk of developing TNS from personal and professional smartphone use. Although various interventions exist to manage TNS, to the authors’ knowledge, no published trial has examined a combined neuromuscular and real-time behavioral-feedback approach in physiotherapists with TNS.

Aims: The aim of this study was to evaluate the impact of real-time smartphone ergonomic monitoring on the implementation of the Proprioceptive Neuromuscular Facilitation (PNF) technique on pain, cervical range of motion (ROM), disability and forward head posture in physiotherapists with TNS.

Design: This study was an assessor-blinded parallel-group randomized controlled trial, conducted in accordance with the CONSORT 2010 statement.

Methods: Sixty-six physiotherapists were recruited. Inclusion criteria was a craniovertebral angle (CVA) < 50º, Numeric Pain Rating Scale (NPRS) ≥ 3 and Neck Disability Index (NDI) ≥ 10. Participants were randomized to Group A (n = 33) to receive PNF combined with a smartphone ergonomic monitoring application, or to Group B (n = 33) to receive PNF only. PNF was delivered 3 times a week for 8 weeks. Groups were assessed by the same outcome assessors who were blind to group allocation. Primary outcomes were pain and cervical ROM assessed by a goniometer. The secondary outcomes were NDI and CVA (photographic analysis).

Outcomes were assessed at baseline, 4 weeks and 8 weeks. Analyses of variance (ANOVA) were performed to assess within-group change and independent samples t-tests to assess between group changes (p < 0.05).

Results: Sixty-three participants (Group A, n = 31; Group B, n = 32) completed the trial and were analyzed according to the protocol. Within-group analyses demonstrated significant improvements of all nine outcomes (p < .001). At week eight, Group A demonstrated more improvement than Group B in pain (NPRS 2.33 ± 1.49 vs. 3.94 ± 1.57; p < .001, d = -1.05), neck disability (NDI 12.44 ± 3.33 vs. 17.06 ± 5.55; p < .001, d = -1.01), craniovertebral angle (49.93° ± 3.08 vs. 46.88° ± 3.23; p < .001, d = 0.97), cervical extension (p = .010, d = 0.68), left lateral flexion (p = .012, d = 0.65), and left rotation (p = .002, d = 0.82). Differences in flexion, right lateral flexion and right rotation, favored Group A, and were not significant. Because cervical flexion differed between groups at baseline (p = .038), supplementary baseline-adjusted analyses were added; after adjustment, differences favored Group A in all six movement directions.

Conclusion: The addition of real-time smartphone ergonomic monitoring to a traditional PNF protocol improved pain, disability, and craniovertebral angle and a range of cervical movements in a group of physiotherapists with Text Neck Syndrome more than PNF alone. The results encouraged the author to combine Continuous Behavioral Feedback and Neuromuscular Rehabilitation for the management of occupational TNS.

Ethics approval: IRB, The Superior University, Lahore (Ref. IRB/FAHS/REHAB/04/26/MS/RS-4020).