Dynamic Neuromuscular Stabilization Exercises: A Comparative Study of Their Effectiveness Via Face-to-Face and Telerehabilitation Delivery
试验速览
- 阶段
- 不适用
- 状态
- 招募中
- 入组人数
- 34
- 试验地点
- 1
- 主要终点
- Spirometric Pulmonary Function FEV1
研究概览
简要总结
This study aims to compare the effects of Dynamic Neuromuscular Stabilization (DNS) exercises delivered face-to-face (YDNS) and via tele-rehabilitation (TDNS) on respiratory function, balance, posture, core endurance, and deep stabilization system performance in healthy adults. A total of 34 participants will be randomly assigned to YDNS or TDNS groups and complete an identical 6-week DNS exercise program (3 sessions per week). Assessments will be conducted at baseline and post-intervention, including pulmonary function, Y-Balance Test, posture analysis, McGill's core stability tests, deep stabilization assessment, and patient satisfaction. All evaluations will be performed face-to-face by certified physiotherapists.
详细描述
Dynamic Neuromuscular Stabilization (DNS) is a manual and rehabilitative approach based on developmental kinesiology principles, aiming to optimize movement by integrating postural alignment, breathing patterns, and motor control. DNS emphasizes the coordination of body segments to maintain a neutral functional position, facilitate precise muscle contractions for both respiration and posture, and reflexively regulate the diaphragm and core stabilizers. It has been tested in various musculoskeletal and neurological conditions, improving breathing efficiency, posture, and core stability through targeted activation of deep stabilizing muscles.
Modern sedentary lifestyles, poor ergonomics, and emotional stress have been strongly associated with spinal misalignment and dysfunctional breathing. Literature highlights that even minor postural deviations significantly affect diaphragmatic mechanics and breathing function. Consequently, proper postural alignment and restoration of optimal diaphragmatic activity are essential for integrated stabilization and respiratory function. DNS-based training provides a clinically valuable tool to address these dysfunctions.
Although DNS has been studied in multiple clinical contexts, little is known about the potential differences between its face-to-face (yDNS) and telerehabilitation (tDNS) delivery methods. With the rise of remote rehabilitation practices during the COVID-19 pandemic, it remains unclear whether DNS, as a complex intervention, can be delivered effectively via telerehabilitation.
Objective
This study aims to compare the effects of telerehabilitation-based DNS (tDNS) and face-to-face DNS (yDNS) on respiratory function, postural alignment, balance, and core stabilization in healthy young adults. The findings are expected to provide novel insights into the clinical applicability of DNS through both in-person and remote rehabilitation modalities.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Other
- 盲法
- Single (Investigator)
入排标准
- 年龄范围
- 18 Years 至 35 Years（Adult）
- 性别
- All
- 接受健康志愿者
- 是
入选标准
- •Aged between 18 and 35 years.
- •Not engaged in regular physical activity within the past 6 months.
- •No history of musculoskeletal disorders or chronic diseases.
- •Able to participate consistently in the exercise program.
- •For the Tele-DNS (TDNS) group: access to reliable internet and appropriate technical equipment for the duration of the intervention.
排除标准
- •Diagnosis or history of neurological, cardiovascular, respiratory, or metabolic diseases.
- •History of spinal or extremity surgery.
- •Pregnancy.
- •Presence of postural deformities or any orthopedic conditions that may affect balance.
研究组 & 干预措施
T-DNS
干预措施: DNS Exercises via Telerehabilitation (Other)
F-DNS
干预措施: Face-to-face DNS Exercises (Other)
结局指标
主要结局
Spirometric Pulmonary Function FEV1
时间窗: Through study completion, an average of 1 year
Pulmonary function will be assessed in the sitting position using a portable spirometer (Cosmed Pony FX, Italy) in accordance with the American Thoracic Society (ATS) guidelines. Before the test, participants will be instructed to wear loose and comfortable clothing and to avoid heavy meals immediately before the assessment. Participants will also be advised to temporarily discontinue specific inhaled medications if instructed by their physician. For the test, participants will sit in an upright position and will be fitted with a nose clip. They will place their lips tightly around a disposable mouthpiece connected to the spirometer. After taking a maximal deep inspiration, participants will be instructed to exhale into the mouthpiece as forcefully and rapidly as possible until complete expiration.
Spirometric Pulmonary Function FVC
时间窗: Through study completion, an average of 1 year
Pulmonary function will be assessed in the sitting position using a portable spirometer (Cosmed Pony FX, Italy) in accordance with the American Thoracic Society (ATS) guidelines. Before the test, participants will be instructed to wear loose and comfortable clothing and to avoid heavy meals immediately before the assessment. Participants will also be advised to temporarily discontinue specific inhaled medications if instructed by their physician. For the test, participants will sit in an upright position and will be fitted with a nose clip. They will place their lips tightly around a disposable mouthpiece connected to the spirometer. After taking a maximal deep inspiration, participants will be instructed to exhale into the mouthpiece as forcefully and rapidly as possible until complete expiration.
Spirometric Pulmonary Function FEV1/FVC ratio
时间窗: Through study completion, an average of 1 year
Pulmonary function will be assessed in the sitting position using a portable spirometer (Cosmed Pony FX, Italy) in accordance with the American Thoracic Society (ATS) guidelines. Before the test, participants will be instructed to wear loose and comfortable clothing and to avoid heavy meals immediately before the assessment. Participants will also be advised to temporarily discontinue specific inhaled medications if instructed by their physician. For the test, participants will sit in an upright position and will be fitted with a nose clip. They will place their lips tightly around a disposable mouthpiece connected to the spirometer. After taking a maximal deep inspiration, participants will be instructed to exhale into the mouthpiece as forcefully and rapidly as possible until complete expiration.
Y-Balance Test
时间窗: Through study completion, an average of 1 year
Dynamic balance will be assessed using the Y-Balance Test. Four measuring tapes will be positioned on the floor to form intersecting lines, creating a star-shaped grid with 45° angles. Only three directions will be tested: anterior (A), posteromedial (PM), and posterolateral (PL). Participants will place their dominant foot at the center of the grid while reaching as far as possible with the opposite foot in the specified directions. The plantar surface of the first metatarsophalangeal joint of the stance foot will be required to remain at the grid center to ensure consistency. Testing will begin in the anterior direction and proceed clockwise. During posterolateral reaching tasks, participants will be instructed to reach behind the stance leg. Each participant will perform three practice trials followed by three test trials in each direction. The average of the three test trials will be recorded as the test score. To account for limb length differences, normalized reach distance will
Biering-Sorenson Test
时间窗: Through study completion, an average of 1 year
Trunk extensor endurance will be assessed using the Biering-Sørensen Test. Participants will be positioned prone on a treatment table with their anterior superior iliac spines aligned with the table edge, allowing the upper body to extend beyond the edge. Stabilization straps will be applied across the pelvis, thighs, and lower legs to secure participants to the table. With arms crossed over the chest, participants will be instructed to lift their trunk until it is parallel to the floor. A digital inclinometer will be placed between the scapulae to monitor trunk angle. Participants will be asked to maintain this horizontal position for as long as possible. The holding time will be recorded with a stopwatch. The test will be terminated when the trunk angle deviates more than 10° from the starting position or when the participant voluntarily stops.
Trunk Flexor Test
时间窗: Through study completion, an average of 1 year
Trunk flexor will be assessed using the Trunk Flexor Test. Participants will be positioned with the trunk at 60° of flexion, while the hips and knees are maintained at 90° of flexion. The arms will be crossed over the chest. Participants will be instructed to maintain this position for as long as possible. The test will be terminated when the participant can no longer hold the position. The duration (in seconds) will be recorded with a stopwatch.
Side Plank Test
时间窗: Through study completion, an average of 1 year
Side plank will be assessed using the Side Plank Test on a mat, performed on the dominant side. Participants will extend their legs so that the knees and feet are aligned. While lifting the hips off the mat, body weight will be supported only by the lower elbow and feet. The test will be terminated when the side plank position deteriorates or the hips drop. Test duration will be recorded in seconds.
次要结局
- Posture(Through study completion, an average of 1 year)
- Deep Stabilization System (DSS) Function Assessment(Through study completion, an average of 1 year)
- Treatment Satisfection(Through study completion, an average of 1 year)
研究者
Çiçek Günday
Asst. Prof.
Istinye University