Effects of Schroth-Based Exercise on Kyphosis Angle, Muscle Strength, Balance, Pain, and Quality of Life in Hyperkyphosis With Chronic Neck Pain
- Conditions
- Postural KyphosisChronic Neck Pain
- Registration Number
- NCT06835608
- Lead Sponsor
- Baskent University
- Brief Summary
This randomized controlled trial aims to evaluate the effects of a Schroth-based three-dimensional exercise program on kyphosis angle, trunk muscle strength, balance, pain, and quality of life in individuals with postural hyperkyphosis and chronic neck pain. The primary objective is to investigate the impact of Schroth 3D exercises and posture correction exercises on thoracic kyphosis angle, trunk extensor strength, endurance, and balance in adults with postural kyphosis.
Inclusion criteria are: adults aged 20-50 years with a thoracic kyphosis angle \>40°, chronic neck pain lasting more than 3 months, VAS score ≥3, no treatment for postural kyphosis in the past 6 months, and absence of systemic disorders.
Exclusion criteria include history of trauma or surgery in the spine, rheumatologic or metabolic disorders, congenital postural deformities, and scoliosis.Participants will be randomly assigned into two groups via computer software: a Schroth-based exercise group and a control group. The intervention will last 8 weeks. During the first 4 weeks, both groups will receive 20 sessions of combined electrotherapy and exercise. After the 4th week, electrotherapy will be discontinued, and exercises will continue 3 times per week for the remaining 4 weeks.The study group will receive 30-minute electrotherapy (hot pack, ultrasound, TENS) applied to the cervical and thoracic regions in each session, followed by Schroth-based posture correction exercises. The control group will receive the same electrotherapy protocol applied only to the neck region and will also perform posture correction exercises not based on Schroth principles.
Outcome measures include thoracic kyphosis angle, trunk extensor muscle strength and endurance, pain severity, balance parameters, and quality of life. These will be assessed by a physiotherapist blinded to group assignment at baseline, at the end of the 4th week, and after completion of the 8-week intervention.
- Detailed Description
Introduction and Objective: The normal thoracic kyphosis angle of the spine is 20-40°, however, an angle of more than 40° is referred to as postural kyphosis, increased kyphosis or hyperkyphosis. Postural kyphosis has been observed to be prevalent among young people and adults, often attributable to factors such as reduced physical activity levels, muscle weakness, and the adoption of incorrect postural habits. This phenomenon is further compounded by the increasing prevalence of computer and smartphone usage, which has been concomitant with technological advancements.In the course of research, the incidence of hyperkyphosis deformity was determined to be 15% in the adolescent period, 38% in adults aged 20-50 years, and 35% in adults aged 20-64 years.
The normal curvatures of the spine in the sagittal plane may vary due to a number of factors. Sagittal plane changes in the spine may be observed in a number of diseases and conditions, including ankylosing spondylitis, muscular dystrophies, poliomyelitis; traumas such as spinal cord injuries and fractures; osteoporosis, muscle weakness, decreased activity level or incorrect postural habits. Postural kyphosis, otherwise known as postural hyperkyphosis, is a prevalent spinal curvature that arises when elevated external loads are exerted on individuals with diminished general muscle strength while in a standing posture. Deviations from the physiological curvature of the spine, such as hyperkyphosis, are considered to be an etiological factor in musculoskeletal pathological conditions .
Increasing thoracic kyphosis, spinal extensor muscle weakness, decreased spinal extension mobility, lumbo-pelvic pain, muscle activation and displacement of the scapula with changing traction angles have been associated with postural changes. It is evident that such alterations in posture have a biomechanical effect on the cervical and lumbar vertebrae. The thoracic spine serves as the foundation for the cervical spine, exerting a significant influence on cervical kinematics through the cervicothoracic junction. It is imperative to note that simultaneous movement of the thoracic spine is necessary to provide the full range of motion of the cervical region. Due to the anatomical proximity between the two regions, any mechanical dysfunction within the thoracic spine may result in alterations within the cervical spine. Research has demonstrated that alterations in postural mechanics of the thoracic spine result in changes to the mechanical loading of the cervical spine. The presence of thoracic dysfunction has been documented in individuals experiencing chronic neck pain.Increases in both the thoracic kyphosis angle and flexor posture have been demonstrated to result in anterior displacement of the central gravity line. Displacement of the body's centre of gravity anteriorly has the potential to exert adverse effects on postural control. Research has demonstrated that postural alterations associated with hyperkyphosis exert a detrimental influence on both static and dynamic balance. The association between postural changes and spinal extensor muscle weakness, increased kyphotic posture, decreased spinal extension mobility, lumbo-pelvic pain, muscle activation and displacement of the scapula with changing traction angles has been demonstrated. These postural changes have been demonstrated to exert a detrimental effect on postural stability, back pain, physical performance and quality of life.
Despite the deleterious effects of postural kyphosis on an individual's general health, physical performance and quality of life, there is an absence of a standardised protocol to correct the thoracic kyphosis angle. Initial treatment methods for individuals with postural kyphosis are conservative in nature. In the extant literature, a range of conservative treatment approaches are employed for the purpose of increasing thoracic kyphosis angle. These include postural correction training and exercises, manual therapy methods, postural corrective kinesiotape applications and orthosis use. In clinical practice, the most prevalent applications for the treatment of postural kyphosis are corrective exercise programmes.
Schroth exercises are a three-dimensional exercise programme developed by Katharina Schroth in Germany in the 1920s for the treatment of scoliosis and spinal deformities. The treatment is characterised by its configuration in the sagittal, frontal and horizontal planes, thereby signifying that the exercise programme is conducted in three dimensions. In Schroth training, the exercises are based on positional correction of the cervical, thoracic and lumbar regions in the sagittal plane, together with spinal elongation, special breathing techniques and re-education of the neuromuscular system. The purpose of this is to improve postural perception. As with scoliosis-specific exercises, the fundamental principles of the specific exercise programme for hyperkyphosis are positional and active stretching of the anterior pectoralis muscles, in conjunction with increasing muscle strength of the back extensors and lower extremities. The method is founded on the principles of sensorimotor and kinesthetic learning. The patient is taught individual correction through the use of sensorimotor feedback mechanisms, which serve to strengthen the muscles surrounding the spine through the adoption of a newly created posture. The method has been shown to synchronise postural perception and movement with visual stimulation in front of a mirror. As evidenced by the extant literature, Schroth-based exercises are extensively employed in the management of rigid kyphosis. The efficacy of Schroth treatment in the prevention and improvement of the thoracic curve angle in patients with Scheuermann's kyphosis has been reported. Despite the plethora of studies in the literature that demonstrate the efficacy of the treatment for scoliosis, the number of studies conducted on kyphosis remains comparatively limited. However, reorganisation of the neuromuscular system and the mechanism of action have the potential to be effective in thoracic kyphosis as in scoliosis. The objective of the present study was to investigate the effects of the Schroth 3D exercise programme and posture corrective exercises on kyphosis angle, trunk extensor muscle strength and endurance, and balance in adults with postural kyphosis.
Hypotheses of the Study ; H1: Schroth-based three dimensional exercise programme applied to adults with postural kyphosis has an effect on reducing the thoracic kyphosis angle.
H2: Schroth-based three dimensional exercises applied to adult individuals with postural kyphosis have an effect on balance parameters.
H3: Schroth-based three dimensional exercises applied to adult individuals with postural kyphosis have an effect on increasing trunk extensor strength.
H4: Schroth-based three-dimensional exercises applied to adult individuals with postural kyphosis have an effect on reducing pain and improving quality of life.
H01: Schroth-based three dimensional exercise programme applied to adults with postural kyphosis has no effect on the reduction of thoracic kyphosis angle.
H02: Schroth-based three dimensional exercises applied to adults with postural kyphosis have no effect on balance parameters.
H03: Schroth-based three dimensional exercises applied to adult individuals with postural kyphosis have no effect on increasing trunk extensor strength.
H04: Schroth-based three-dimensional exercises applied to adult individuals with postural kyphosis have no effect on reducing pain and improving quality of life.
Materials and Methods :
The present study is a randomised controlled trial designed to evaluate the effects of a Schroth-based three-dimensional exercise programme on kyphosis angle, trunk muscle strength, balance parameters, pain and quality of life in individuals with postural hyperkyphosis and chronic neck pain. The study will include individuals diagnosed with postural hyperkyphosis and chronic neck pain, who are currently receiving treatment at the Ümitköy Physical Therapy Outpatient Clinic of Ankara University Hospital in Ankara.
Individuals aged between 20 and 50 years with a thoracic kyphosis angle measuring above 45 degrees, individuals with neck pain for a period of more than three months with a Vas value of 3 and above, individuals who have not received treatment for postural kyphosis in the last six months and who do not have a systemic disorder will be included in the study. The following individuals will be excluded from the study:
* Those with a history of trauma or surgery to the spine joints
* Those with rheumatological or metabolic disorders
* Those with congenital postural deformities or scoliosis. In the present study, subjects will be randomly allocated to either the Schroth-based three-dimensional exercise group or the control group, with the allocation process being conducted using a computer programme. The randomisation of patients is to be conducted in accordance with the Random Allocation Software 2.0 programme .
The present study was meticulously designed as a Schroth-based three-dimensional exercise group and a control group, with a duration of eight weeks. The two groups will both undergo a programme comprising 20 sessions of electrotherapy and exercise, to be administered over a period of four weeks. Subsequent to the completion of the fourth week of electrotherapy sessions, the exercise applications will be continued for a further four weeks by the physiotherapist responsible for the study, who will undertake the programme three days per week. The intervention will consist of a series of educational sessions focusing on the development of postural perception, with a particular emphasis on the identification of postural kyphosis and the adoption of optimal posture in daily living. These educational sessions will be administered to both groups. The training programme will be delivered in a practical manner by the physiotherapist. A brochure will be provided to patients, serving as a reference guide for the exercises and considerations.
Electrotherapy treatment, encompassing modalities such as hot packs, ultrasound and tens, will be administered to the neck region for a duration of 30 minutes in each session. Following electrotherapy treatment, individuals will undergo kyphotic posture correction exercises, utilising proprioceptive and extroceptive stimuli in the sagittal plane, with mirror control and specific corrective breathing techniques. In the exercise programme, the exercises are to be performed in specific positions, namely supine, prone, sitting and standing. Each exercise type will be performed in combination with spinal elongation and corrective breathing. During the initial week of the programme, emphasis will be placed on the adoption of proper spinal posture, the execution of fundamental positions, and the incorporation of corrective breathing exercises. In the second and third week of the programme, the application of the kyphosis-specific exercise programme will be complemented by the incorporation of basic positions. In the fourth week, all exercises will be repeated and the number of sets will be increased. The exercise programme is to be planned for approximately 40 minutes in each session. Following the conclusion of the treatment programme, patients will be provided with a series of exercises to be performed at home.
In the control group, the intervention consists of electrotherapy treatment (ultrasound, tens, hotpack) applied to the neck area for a duration of 30 minutes in each session. Following the administration of electrotherapy, corrective exercises for posture will be applied to the subjects. A corrective exercise programme for posture should consist of the following:
* Deep neck flexor muscle strengthening exercises
* Strengthening of the lower and middle trapezius muscles
* Isometric neck exercises All strengthening exercises will be administered in the form of three sets of ten repetitions per day, with each repetition lasting ten seconds. Stretching exercises will be administered to the shortened upper trapezius and pectoralis major muscles. The stretching exercises will be performed in two sets of five repetitions per day, with each repetition lasting 20 seconds. A brochure will be provided to patients, which will include home exercise programmes and points to consider.
The study group will be subjected to a series of Schroth-based three-dimensional exercises in combination with positional corrective exercises and respiratory exercises. These are the exercise methods routinely applied to individuals with postural hyperkyphosis and chronic neck pain in a clinical setting. Posture exercises to be administered to the control group are the routine exercise method regularly applied in the clinic to individuals with postural hyperkyphosis with chronic neck pain.
Statistical analyses will be conducted using the SPSS v25.0 software programme. In the context of the evaluation of categorical variables, the utilisation of frequency (n) and percentage (%) values as descriptive statistics is imperative. The Shapiro-Wilk normality test will be used to ascertain the conformity of numerical variables to a normal distribution, and to provide descriptive statistics. Mean ± standard deviation values will be given for variables that are suitable for normal distribution, and median (minimum-maximum) values will be given for those that are not suitable for normal distribution. The appropriate hypothesis testing methods planned to be used in the study will be 'Pearson Chi-Square' when the necessary assumptions for the examination of categorical variables are met, and 'Freeman-Halton test (Fisher's Exact test)' when they are not met. The statistical test employed to ascertain the presence of a discrepancy between two independent groups with regard to quantitative variables is referred to as 'Student's t test'. This test is implemented provided that the parametric test assumptions are met; conversely, if these assumptions are not met, the 'Mann-Whitney U test' is utilised. In circumstances where the parametric test assumptions are met, the difference between two dependent groups will be analysed by 'Dependent two sample t-test'. Conversely, when these assumptions are not met, the 'Wilcoxon Rank Number Test' will be utilised. The relationship between variables will be analysed by Pearson Correlation Test when parametric test assumptions are met and by Spearman Correlation Test when parametric test assumptions are not met. In the context of hypothesis testing, the probability of Type I error is conventionally set at α=0.05. It is imperative that a sample is obtained for the purpose of testing the research hypothesis.
When the values shown in the literature in terms of the outcome measurements to be used were examined, the values of each parameter both before and after the treatment were analysed by comparing them one by one in order to determine the adequate sample size and according to the result of this analysis; it was found that 52 patients for each group were sufficient for our study to have 95% power. In our study, the sample size was planned to be 26 for each group, totalling 52 patients.
Evaluation Methods The evaluation of the individuals will be performed by the physiotherapist before the treatment, at the end of the 4th week and at the end of the treatment (at the end of the 8th week).
Physical Characteristics of the Cases Sociodemographic information such as age, gender, occupational status, height, weight, body mass index, pain history, history of drug use will be recorded.
Thoracic Kyphosis Angle Measurement Flexible Ruler and Inclinometer In our study, kyphosis angles of individuals will be measured with flexible ruler and inclinometer. In the literature, C7- T12 spinal processes have been shown as a reference in the measurement of thoracic kyphosis. Individuals will be asked to lie in prone position and C7, T1, T12 spinous processes will be marked with a pencil by palpation. Individuals will be asked to stand with their face to the wall and arms free. A flexible ruler will be placed on the marked reference points. The flexible ruler will be placed on millimetrically divided paper without distorting its shape. The angular value of the curvature drawn on the paper from the contour of the flexible ruler will be calculated with the formula.
Another kyphosis angle will be measured with an inclinometer (J-Tech Dualer IQ Digital inclinometer Fabrication Enterprises, Ny, USA) available in our clinic. In the inclinometer measurement, the individuals will be asked to stand facing the wall with their arms free as in the flexible ruler. Measurements will be made by placing an inclinometer on the marked C7-T12 spinal processes. The validity and reliability of the inclinometer method used to measure the kyphosis angle have been reported in previous studies.
Head Protrusion Measurement in Postural Assessment Occiput Wall and Tragus Wall Distance Tragus wall distance (TDM) measurement is performed to determine the anterior tilt of the head. With the neck in a neutral position and the jaw closed, the distances between the occiput - wall and tragus - wall in the sagittal plane will be measured with a tape measure. The average of both measurements will be calculated and recorded in cm.
Trunk Extensor Muscle Strength In our study, trunk extensor muscle strength of individuals will be measured with a hand-held dynamometer (Lafayette hand-held dynamometer model 01165 JTech, USA). Individuals will lie face down and place their hands on their foreheads while trunk extensor muscle strength is measured. The dynamometer will be placed at the T4 level of the individuals and the measurement will be made perpendicular to the trunk. Individuals will be instructed to generate isometric trunk extension force for 2 seconds and then maximal isometric hold for 5 seconds. The measurement will be repeated 3 times.
Trunk Flexor Muscle Strength In our study, trunk flexor muscle strength of individuals will be measured with a hand-held dynamometer (Lafayette hand-held dynamometer model 01165 JTech, USA). Individuals will be asked to be placed in the supine and knees straight position while measuring trunk flexor muscle strength. The dynamometer will be placed at the sternum level and the measurement will be made perpendicular to the trunk. Participants will be asked to cross their hands over their chest. Individuals will be instructed to generate isometric trunk flexion force for 2 seconds followed by 5 seconds of maximal isometric hold. The measurement will be repeated 3 times.
Balance assessment Tetrax posturography device (Tetrax Potable Multiple System, Tetrax Ltd., Ramat Gan, Israel) is a device that allows objective assessment and recording of postural stability and fall risk. Measurements will be made in 8 different positions; eyes open and closed, head straight, head straight with sponge on the soles of the feet with eyes open and closed, head rotation to the right and left with eyes closed, full extension and flexion of the neck with eyes closed. For each case, the general stability index (SI), which is based on assessing the displacement of the centre of gravity, and weight distribution measurements (WDI) on four platforms will be performed.
Spinal Stabilisation Activity Spinal stabilisation activity was assessed with the Stabiliser Pressure Biofeedback device (PBU; Chattanooga Group-Australia). This assessment does not involve an invasive procedure. The pressure biofeedback device is a practical tool used in clinical practice to measure the pressure generated by the TA and M muscles during activation, with emphasis on segmental stabilisation. The device consists of two parts: a 30-air section with a pressure gauge and a section that senses the pressure applied by the patient. The pressure gauge of the device is between 0-200 mm Hg. There is an inflation unit (manometer) connected to the gauge of the device. The measurement will be performed with the patient in prone position. The inflation unit of the device will be placed under the patient's umbilicus, above the SIAS (spina iliaca anterior superior). Before asking the patient to perform the muscle movement, the device pressure will be adjusted to 70 mm Hg. The patient will be asked to slowly press the lower abdomen against the pressure unit without holding his/her breath or moving his/her back and hips and maintain this position for 10 seconds.
Assessment of Pain Visual Analogue Scale (VAS) VAS will be used to assess the severity of neck pain. On a 10 cm long ruler divided into equal intervals, the patient will be asked to mark the intensity of the pain felt in the last 1 week. A value of 0 indicates no pain and a value of 10 indicates the most severe pain. The measurement results will be used to evaluate the pain level.
Assessment of Disability and Quality of Life Neck Disability Index (NDI) The Neck Disability Index (NDI) is a self-reported questionnaire designed to assess neck pain-related disability. It consists of 10 items addressing daily activities such as personal care, lifting, reading, work, driving, sleeping, recreational activities, pain intensity, concentration, and headache. Each item is scored on a 6-point Likert scale ranging from 0 (no disability) to 5 (complete disability). The total score is calculated by summing the scores of all items and multiplying by two, resulting in a final score ranging from 0 to 100, where higher scores indicate a greater level of disability. In this study, the NDI will be used to evaluate neck-related functional limitations of participants, with scores expressed as a percentage of maximum possible disability.
Quality of life assessment The Scoliosis Research Society-22 (SRS-22) Questionnaire is a widely accepted, simple, and practical tool developed by the Scoliosis Research Society to assess health-related quality of life in individuals with spinal deformities. In this study, the SRS-22 will be used to evaluate the quality of life of participants.
The questionnaire consists of 22 items grouped into five domains: pain, self-image/appearance, function/activity, mental health, and satisfaction with treatment. Each item is scored on a 5-point Likert scale, ranging from 1 (worst outcome) to 5 (best outcome). The total score is calculated by averaging the item scores within each domain or across all items. Higher scores reflect better health-related quality of life.
Scientific Contribution and Expectations The present study is intended to contribute to the existing literature and to inform clinical practice by investigating the effects of a Schroth-based three-dimensional exercise programme on kyphosis angle, trunk muscle strength, balance parameters, pain and quality of life in individuals with postural hyperkyphosis and chronic neck pain. It is hypothesised that the three-dimensional exercise programme that will be applied for postural hyperkyphosis in adult subjects will provide a novel perspective on the clinical and literary evidence. It is hypothesised that individuals with postural hyperkyphosis will benefit from this gain in terms of preventing possible complications in the future. It is hypothesised that the results obtained from this study will contribute to future studies and clinical applications.
Recruitment & Eligibility
- Status
- ACTIVE_NOT_RECRUITING
- Sex
- All
- Target Recruitment
- 52
- Thoracic kyphosis angle > 45 degrees,
- Aged between 20 and 50 years,
- Have neck pain for more than 3 months,
- Neck pain visual analogue scale > 3,
- Not being treated for postural kyphosis in the last 6 months,
- Has no systemic disease
- History of trauma or surgery on spinal joints,
- Participants with rheumatological and metabolic disorders,
- Participants with congenital postural deformity and scoliosis
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Primary Outcome Measures
Name Time Method Angle of thoracic kyphosis Baseline,4th week, 8th week The kyphosis angles of the participants will be measured using a flexible ruler and an inclinometer.As stated in the literature, thoracic kyphosis will be measured from C7-T12 spinal processes.Prior to molding the flexicurve ruler to the subject's spine, the C7 and T12 posterior spinous processes were located via palpation.The flexicurve ruler was then molded over the spine midline from C7 to T12. The resulting curve was traced on paper, and the locations of the C7 and T12 processes were labelled. The measurement was performed while the participant stood in a neutral upright posture with feet shoulder-width apart.The flexible ruler will be placed on the marked reference points. It will then be placed on the millimetrically divided paper without distorting its shape. The angular value of the curvature drawn on the paper from the contour of the flexible ruler will then be calculated. Another kyphosis angle will be measured by the same procedure using an inclinometer.
- Secondary Outcome Measures
Name Time Method Trunk Muscle Strength Baseline,4th week, 8th week In our study, trunk extensor and flexor muscle strengths of participants will be measured with a hand-held dynamometer (Lafayette hand-held dynamometer model 01165 JTech, USA). Trunk extension strength will be measured in a prone position. The dynamometer will be positioned at the T4 level of the subjects, with the measurement being taken perpendicular to the body. Participants will be asked to assume the supine position with their knees straight, in order to measure the strength of their trunk flexor muscles. The dynamometer will be placed at the sternum level, and the measurement will be taken perpendicular to the trunk.Participants will be asked to cross their hands over their chest. In both measurements, participants are instructed to generate an isometric trunk extension force for a duration of two seconds, followed by a maximum isometric hold for five seconds. This measurement is then repeated on three occasions.
Balance Assessment Baseline,4th week, 8th week Tetrax posturography device (Tetrax Potable Multiple System, Tetrax Ltd., Ramat Gan, Israel) is a device that allows objective assessment and recording of postural stability and fall risk.The measurements will be conducted in eight different positions: eyes open and closed with the head in a neutral position, eyes open and closed while standing on a foam surface with the head in a neutral position, eyes closed with the head rotated to the right and left, and eyes closed with the neck in full extension and flexion positions. The general stability index (SI) is to be conducted, with the displacement of each case's centre of mass and anterior-posterior weight distribution measurements being the basis on which it is to be assessed.
Spinal Stabilisation Activity Baseline,4th week, 8th week The assessment of spinal stabilisation activity will be conducted utilising the Stabiliser Pressure Biofeedback device (PBU; Chattanooga Group-Australia).The pressure biofeedback device is a practical tool commonly used in clinical settings to measure the pressure generated during the activation of the Transversus Abdominis and Multifidus muscles, emphasizing segmental stabilization. The pressure gauge of the device ranges from 0 to 200 mmHg and is connected to an inflation unit (manometer). The measurement will be conducted with the patient in the prone position. The inflation unit of the device will be placed under the patient's umbilicus, positioned above the ASIS (anterior superior iliac spines). Before asking the patient to perform any muscle movement, the device's pressure will be set to 70 mmHg. Participants will be instructed to take a deep breath and gently draw the umbilicus toward the lumbar vertebrae, maintaining this position for 10 seconds
Visual Analogue Scale (VAS) Baseline,4th week, 8th week The VAS (Visual Analogue Scale) will be utilised to evaluate the severity of neck pain. The patient will be requested to indicate the intensity of discomfort experienced over the preceding seven days on a 10-centimetre ruler that has been segmented into equal divisions. A score of 0 indicates an absence of pain, while a score of 10 represents the most severe pain. The measurement results will be used to assess the pain intensity.
Occiput Wall and Tragus Wall Distance Baseline,4th week, 8th week To determine the anterior tilt of the head, the Tragus-to-Wall Distance will be measured. The participants should stand upright with their heels and back against the wall, maintaining a neutral neck position and closed chin. The distances between the occiput and the wall, as well as the tragus and the wall, will be measured using a tape measure in the sagittal plane. The average of these two measurements will then be calculated and recorded in centimetres.
Neck Disability Index Baseline,4th week, 8th week The Neck Disability Index (NDI) is a self-reported questionnaire designed to assess neck pain-related disability. It consists of 10 items addressing daily activities such as personal care, lifting, reading, work, driving, sleeping, recreational activities, pain intensity, concentration, and headache. Each item is scored on a 6-point Likert scale ranging from 0 (no disability) to 5 (complete disability). The total score is calculated by summing the scores of all items and multiplying by two, resulting in a final score ranging from 0 to 100, where higher scores indicate a greater level of disability. In this study, the NDI will be used to evaluate neck-related functional limitations of participants, with scores expressed as a percentage of maximum possible disability.
Assessment of Quality of Life Baseline,4th week, 8th week The Scoliosis Research Society-22 (SRS-22) Questionnaire is a widely accepted, simple, and practical tool developed by the Scoliosis Research Society to assess health-related quality of life in individuals with spinal deformities. In this study, the SRS-22 will be used to evaluate the quality of life of participants. The The questionnaire consists of 22 items grouped into five domains: pain, self-image/appearance, function/activity, mental health, and satisfaction with treatment. Each item is scored on a 5-point Likert scale, ranging from 1 (worst outcome) to 5 (best outcome). The total score is calculated by averaging the item scores within each domain or across all items. Higher scores reflect better health-related quality of life.
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Trial Locations
- Locations (1)
Baskent University Umitkoy Outpatient Clinic
🇹🇷Ankara, Çankaya, Turkey