Effects of Telerehabilitation-based Motor Imagery and Exercise Combination in Individuals With Postural Kyphosis: A Randomized Controlled Trial

NCT07122791 | Completed

• 1 other identifier: BingolUni
• Study Type: interventional
• Target: 35
• Locations: 1 country
• Sites: 1

Brief Summary

Objective: Kyphosis is one of the most common postural problems. It is defined as a thoracic curvature that exceeds normal limits. The Cobb angle, also known as the kyphosis index, can be used to determine the degree of this curvature. Motor imagery (MI) is defined as visualising movement in the mind without actually moving. Studies have shown that similar brain regions are activated during motor imagery and actual movement. regions are activated during motor imagery and actual movement. Most of the information about motor imagery training has been obtained from studies of stroke patients, and the physical effects of motor imagery training have been examined in these studies. However, there has been no study in which motor imagery, which is mostly performed by neurological stroke groups or athletes, is used for treatment of postural disorders. In this context, this study aims to examine the effect of tele-rehabilitation-based motor imagery training on kyphotic angle, pain, depression and quality of life in individuals with posture disorders. Materials and methods: Young adults with postural kyphosis who are studying at Istanbul University-Cerrahpaşa Faculty of Health Sciences will be included in the randomised controlled, single-blind, prospective study. Participants will be randomly divided into two groups: an exercise group (Group 1) and an exercise + motor imagery group (Group 2). The presence of kyphosis in participants will be evaluated by measuring the Flexruler kyphosis index and wall-occiput distance. Posture will be evaluated using the New York Posture Analysis and pain using a visual pain scale. Depression will be assessed using the Beck Depression Scale. assessment will be evaluated using the Beck Depression Scale; quality of life will be evaluated using the SRS-22; and motor imagery will be evaluated. ability will be evaluated using the Turkish version of the Movement Visualisation Questionnaire-3 (MIQ-3). SPSS (Statistical Package for the Social Sciences) Sciences) statistical program (SPSS 21.0) will be used to analyse the obtained data, with p\<0.05 being significant.

Conditions

Posture; Kyphosis; Muscle Cramps; Thoracic Vertebrae

Keywords

Telerehabilitation; Manipulation, Orthopedic; Posture

Outcome Measures

Primary Outcomes (4)

• THE MOVEMENT IMAGERY QUESTIONNAIRE-3

  The Movement Imagery Questionnaire-3 (MIQ-3) consists of 12 items divided into three subscales: Internal Visual Imagery (IVI), External Visual Imagery (EVI), and Kinesthetic Imagery (KI), each containing four items. Responses are rated on a 7-point Likert scale, where 1 indicates "very hard to see/feel" and 7 indicates "very easy to see/feel." For each subscale, the mean score is calculated by summing the scores of its four items and dividing by four, resulting in a value between 1 and 7. Higher scores reflect a greater ease and ability in performing the specific type of imagery. The MIQ-3 has demonstrated good reliability and validity in various languages, including the Turkish version, where Cronbach's alpha values ranged from 0.68 to 0.79 for the subscales and around 0.86-0.87 for the total scale, with test-retest intraclass correlation coefficients between 0.84 and 0.95. This scoring method allows both individual assessment and group-level analysis of imagery ability.

  Three months

• Visual Analog Scale

  The Visual Analogue Scale (VAS) is a simple, widely used method for measuring subjective experiences such as pain intensity, fatigue, or mood. It typically consists of a 10-centimeter horizontal or vertical line with endpoints labeled to represent the extremes of the sensation being measured, for example, "no pain" at one end and "worst imaginable pain" at the other. Participants are asked to mark a point on the line that best represents their current experience. Higher scores indicate greater intensity of the measured sensation.

  Three months

• New York Posture Rating Scale

  The New York Posture Rating Scale (NYPRS) is an observational tool used to assess overall body posture by systematically evaluating multiple body segments in both the anterior and lateral views. The scale typically examines areas such as the head, shoulders, spine, hips, knees, and feet, assigning each segment a score based on alignment with an ideal posture. Each body part is scored on a scale, often from 5 (good alignment) to 1 (poor alignment), depending on the degree of deviation from the optimal position. The individual segment scores are then summed to produce a total posture score, with higher totals indicating better postural alignment.

  Three months

• Flexruler Kyphosis Index

  The Flexicurve (or Flexruler) Kyphosis Index is a clinical method used to quantify the curvature of the thoracic spine, particularly to assess the degree of kyphosis. The procedure involves placing a flexible ruler (Flexicurve) along the contour of the subject's spine while they are standing in a natural posture. Once the ruler has been molded to match the spinal curvature, its shape is traced onto paper. Two key measurements are then taken from the tracing: the length (L), which is the straight-line distance between the starting and ending points of the curve, and the height (H), which is the maximum perpendicular distance from the length line to the deepest point of the curve. The Kyphosis Index (KI) is calculated using the formula: KI = (H / L) × 100 Higher KI values indicate a greater thoracic curvature. This method is simple, inexpensive, and non-invasive, making it useful for both clinical assessment and research, although it measures curvature indirectly and may be less preci

  Three months

Secondary Outcomes (2)

• Beck Depression Inventory

  Three months

• SRS-22 (Scoliosis Research Society- 22; SRS-22)

  Three months

Study Arms (2)

Group 1: Home Exercise Program Group

EXPERIMENTAL

Home exercise program that includes strengthening and stretching

Other: Home Exercise Group

Group 2: Home Exercise Program + Motor Imagery Training

EXPERIMENTAL

Motor imagery training, in addition to the home exercise program, was applied twice a week for 6 weeks via tele-rehabilitation under the supervision of a physiotherapist.

Other: Home Exercise Group

Interventions

Home Exercise Group OTHER

In addition to the exercise program, Group 2 will receive motor imagery training. This will be carried out using the telerehabilitation method, under the supervision of a physiotherapist, and will be delivered twice a week for six weeks. A text containing posture exercises will be prepared by the physiotherapist for motor imagery training. The motor imagery text will be updated as the home exercise program is completed. The content of the motor imagery program will consist of 5 minutes of relaxation and 15 minutes of imagery training. Relaxation training will include relaxation and breathing exercises. After relaxation training, the patient will be asked to stand up with his eyes closed in a safe environment where he feels comfortable, and then a text containing posture exercises prepared by the physiotherapist for motor imagery will be read. The patient will be asked to perform the exercise by imagining it in his mind without moving his body.

Group 1: Home Exercise Program Group; Group 2: Home Exercise Program + Motor Imagery Training

Eligibility Criteria

• Age: 18 Years - 30 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64)

You may qualify if:

• Having postural kyphosis \[Kyphosis index measured with Flexcurve ruler, greater than 13 (35)\]
• Having sufficient computer/smartphone usage knowledge to participate in the study or having a relative who can help in this regard
• Having a technological device (computer, mobile phone, tablet) and active internet connection at home
• Being between the ages of 18 and 30

You may not qualify if:

• Having a systemic disease
• Being diagnosed with scoliosis
• Having had spinal surgery
• Having a serious cognitive disorder determined by a physician that would prevent the tests

Sponsors & Collaborators

• Istanbul University - Cerrahpasa: lead

Study Sites (1)

Istanbul University- Cerrahpasa, Faculty of Health Science

Istanbul, Turkey (Türkiye)

Location

MeSH Terms

Conditions

Kyphosis; Muscle Cramp

Condition Hierarchy (Ancestors)

Spinal Curvatures; Spinal Diseases; Bone Diseases; Musculoskeletal Diseases; Muscular Diseases; Neuromuscular Manifestations; Neurologic Manifestations; Nervous System Diseases; Signs and Symptoms; Pathological Conditions, Signs and Symptoms

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: TRIPLE
• Who Masked: PARTICIPANT, INVESTIGATOR, OUTCOMES ASSESSOR
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Assistant Professor

Study Record Dates

• First Submitted: October 2, 2024
• First Posted: August 14, 2025
• Study Start: November 15, 2024
• Primary Completion: August 15, 2025
• Study Completion: August 15, 2025
• Last Updated: March 13, 2026

Record last verified: 2026-03

Data Sharing

• IPD Sharing: Will not share

Locations

TU (1)