The Role of Musical Stimulation Intensity on Postural Control in Athletes: A Virtual Reality-Based Posturography Study
Phase: NA
Conditions: Health Adult Subjects, Adults, Athlete
Sponsor: Hanifi Korkmaz

STUDY PROTOCOL AND STATISTICAL ANALYSIS PLAN 
NCT Number: Not Yet Assigned 
 
Official Title: The Role of Musical Stimulation Intensity on Postural Control in Athletes: 
A Virtual Reality-Based Posturography Study 
 
Document Type: Study Protocol and Statistical Analysis Plan 
 
Ethics Approval: Malatya Turgut Özal University Health Sciences Scientific Research 
Ethics Committee 
 
Approval Number: 2025/95 
 
Date: 28 October 2025 
 
Sponsor-Investigator: Asst. Prof. Dr. Hanifi Korkmaz 
 
Affiliation: Malatya Turgut Özal University, Malatya, Türkiye 
 
 
 
 
 
 
 
 
 
 

 
1. Background and Rationale 
Postural stability depends on the integration of visual, vestibular, and somatosensory 
inputs for equilibrium control. Auditory stimulation, particularly music, can modulate 
standing posture through mechanisms such as attentional modulation and stochastic 
resonance, which may alter proprioceptive feedback and motor strategies. The influence 
of different music intensity levels on balance performance in athletes remains 
insufficiently studied, especially using virtual reality-based posturography. This protocol 
evaluates how auditory intensity modulates sensory reweighting and stability indices in 
sport-trained individuals. 
 
2. Objectives 
Primary Objective 
To investigate the effects of different musical intensity levels (low, medium, high) on 
postural control in athletes using VR-based posturography. 
Secondary Objective 
To explore whether individual noise sensitivity moderates balance performance during 
auditory stimulation. 
 
3. Study Design 
This experimental, cross-sectional study used a randomized crossover design. Each 
participant completed balance assessments under three musical intensity conditions (low 
≈55 dB, medium ≈70 dB, high ≈85 dB). Conditions were presented in randomized order, 
and a ≥60-second washout period was provided between trials to minimize carryover 
effects. 
 

4. Participants 
Inclusion Criteria 
• 
Age 18–30 years 
• 
Active athletic training ≥5 years 
• 
Normal hearing thresholds (≤20 dB HL) 
• 
No vestibular, neurological, orthopedic, or psychiatric disorders 
• 
Written informed consent 
Exclusion Criteria 
• 
Current or past vestibular disorder or vertigo 
• 
Intolerance to auditory stimulation 
• 
Ototoxic drug use in the last 3 months 
• 
Abnormal tympanometry 
 
5. Intervention Description 
Auditory stimulation consisted of Mozart’s Jupiter Symphony, delivered via standardized 
VR-integrated headphones (Balance VR system). All participants listened to the same 
musical excerpt at three intensity levels. Balance evaluations were conducted using VR-
based CTSIB and Limits of Stability modules. 
 
6. Outcome Measures 
Primary Outcomes 
• 
CTSIB composite equilibrium score 
• 
Sensory component scores: somatosensory, visual, vestibular, and visual 
preference 
Secondary Outcomes 
• 
LOS metrics: reaction time, endpoint excursion, maximum excursion, mean 
velocity, and directional control 
• 
Noise sensitivity measured using the Weinstein Noise Sensitivity Scale (Turkish 
validated version) 
 

7. Statistical Analysis Plan 
Normality was assessed using the Shapiro–Wilk test. The effects of auditory intensity and 
sport type were analyzed using repeated-measures ANOVA and linear mixed models. 
Bonferroni correction was applied for post-hoc pairwise comparisons. Pearson 
correlations were performed to examine the association between noise sensitivity and 
postural outcomes. Partial eta-squared (η²) was used to estimate effect size. Significance 
level: p < 0.05 (two-tailed). 
 
8. Ethics and Data Handling 
The study was approved by the Malatya Turgut Özal University Health Sciences 
Scientific Research Ethics Committee (Approval No: 2025/95) and adhered to the 
Declaration of Helsinki. All participants signed written informed consent. Data are 
anonymized and securely stored. Individual participant data will not be publicly shared 
due to institutional data protection regulations; only aggregated results may be reported.