Effect of Attentional Focus Order in Home Exercise for Neck Pain

NCT07102199 | Active Not Recruiting

• 1 other identifier: SBETKK2025-4
• Study Type: interventional
• Target: 39
• Locations: 1 country
• Sites: 1

Brief Summary

According to the International Association for the Study of Pain's 2017 terminology, neck pain is described as an unpleasant sensory and emotional experience originating in the cervical region and potentially radiating toward the scapular area, typically linked to actual or potential tissue injury. Although research on how attentional focus instructions influence postural control remains limited, existing findings suggest that the sequence in which these instructions are delivered can impact sensory processing during postural control assessments. These observations raise compelling questions about the potential benefits of using attentional focus strategies in a structured, sequential manner during neck pain treatment. To date, however, no study has investigated how varying the order of attentional focus cues within a home exercise program affects individuals with non-specific neck pain. This study aimed to fill that gap by evaluating the clinical effectiveness of a home-based exercise protocol utilizing attentional focus instructions in different sequences. The primary outcome was disability level, measured by the Neck Disability Index (NDI). Secondary outcomes included pain intensity assessed via the Visual Analog Scale (VAS), craniovertebral angle (CVA) via photogrammetry, pressure pain threshold (PPT), cervical joint range of motion, dizziness-related disability (Dizziness Handicap Inventory), and the endurance of neck flexor and extensor muscles.

Conditions

Neck Pain; Motor Learning; Home Exercise Program

Keywords

attentional focus; mechanical neck pain; craniovertebral angle

Outcome Measures

Primary Outcomes (1)

• Neck Disability Index (NDI)

  The Neck Disability Index (NDI) was used to assess disability resulting from neck pain. The NDI consists of 10 items: four addressing subjective symptoms (pain intensity, headache, concentration, and sleeping), and six assessing activities of daily living (personal care, lifting, reading, work activities, driving, and recreation). Each item is scored on a scale from 0 to 5, with total scores ranging from 0 (no disability) to 50 (maximum disability); lower scores indicate less disability. According to the literature, the minimal clinically important difference (MCID) for the NDI has been reported to be 7 points (Abbott, 2014).

  The assessment will be performed at two time points: baseline and 4 weeks after the intervention.

Secondary Outcomes (7)

• Pain Intensity Based on Visual Analog Pain Scale (VAS)

  The assessment will be performed at two time points: baseline and 4 weeks after the intervention.

• Dizzines Handicap Inventory

  The assessment will be performed at two time points: baseline and 4 weeks after the intervention.

• Craniovertebral angle measurement

  The assessment will be performed at two time points: baseline and 4 weeks after the intervention.

• Pressure Pain Threshold Measurement (PPT)

  The assessment will be performed at two time points: baseline and 4 weeks after the intervention.

• Cervical Joint Range of Motion Measurement

  The assessment will be performed at two time points: baseline and 4 weeks after the intervention.

Study Arms (3)

IFO-First

EXPERIMENTAL

Participants included in the study will follow a home exercise program for 3 days a week for 4 weeks, in accordance with the instructions given to their groups. The IFO-First group will first receive internal attention focus instructions, then external attention focus.

Other: Internal focus of attention instructions- First; Other: Home exercises

EFA-Firts

EXPERIMENTAL

Participants included in the study will follow a home exercise program for 3 days a week for 4 weeks, in accordance with the instructions given to their groups. The EFO-First group will first receive external focus instructions, then internal focus of attention instructions.

Other: External focus of attention instructions- First; Other: Home exercises

CG

ACTIVE COMPARATOR

Participants included in the study will follow a home exercise program without any instructions, 3 days a week for 4 weeks.

Other: Home exercises

Interventions

Internal focus of attention instructions- First OTHER

Participants first received internal focus instructions, directing their attention to their own body, followed by external focus instructions.

IFO-First

External focus of attention instructions- First OTHER

Participants first received internal focus instructions, directing their attention to their own body, followed by external focus instructions.

EFA-Firts

Home exercises OTHER

Participants' home exercise program includes cervical and scapulothoracic stabilization exercises and self-mobilization exercises with the self-sustained natural apophyseal glide (SNAG) method.

CG; EFA-Firts; IFO-First

Eligibility Criteria

• Age: 18 Years - 40 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64)

You may qualify if:

• Aged between 18 and 40 years
• A craniovertebral angle of 53 degrees or less
• A Visual Analog Scale score greater than 3 for pain in the neck and shoulder areas
• Experiencing head and neck pain for a duration exceeding three months
• A Neck Disability Index score ranging from 5 to 24
• A positive result on the cervical flexion-rotation test
• A body mass index within the range of 18.5 to 25 kg/m²
• No history of injury to the neck, trunk, or upper and lower extremities in the past six months

You may not qualify if:

• A positive result on the Spurling test
• Reduced or absent reflex responses in the upper extremities,
• Referred pain scoring greater than 7 on the Visual Analog Scale in the affected dermatome
• Diagnosis of cervical spinal stenosis
• Diagnosis of an autoimmune disorder
• Previous surgical intervention in the cervical or shoulder region
• A positive result on the Vertebrobasilar insufficiency test
• Presence of any musculoskeletal deformity or abnormality
• Inability to carry out functional activities due to visual, auditory, vestibular, or neurological impairments
• Neck pain associated with malignancy or structural abnormalities
• Clinical presentation consistent with a capsular pattern suggestive of arthritis, or the presence of a severe psychological disorder
• Current pregnancy
• Participation in any form of exercise-based treatment or physiotherapy within the last three months

Sponsors & Collaborators

• Büşra Tamgüç: lead
• Istanbul Nisantasi University: collaborator

Study Sites (1)

İstanbul Nişantaşı University

Istanbul, Sarıyer, Turkey (Türkiye)

Location

MeSH Terms

Conditions

Neck Pain

Condition Hierarchy (Ancestors)

Pain; Neurologic Manifestations; Signs and Symptoms; Pathological Conditions, Signs and Symptoms

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: OUTCOMES ASSESSOR
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR INVESTIGATOR
• PI Title: Physiotherapist, Research Assistant

Model Details: This study has a randomized, controlled, single-blind, prospective study design.

Study Record Dates

• First Submitted: July 21, 2025
• First Posted: August 3, 2025
• Study Start: May 1, 2025
• Primary Completion: November 30, 2025
• Study Completion: December 31, 2025
• Last Updated: August 3, 2025

Record last verified: 2025-07

Locations

TU (1)