Effects of Postural Education or Corrective Exercise on Forward Head Posture
Condition: Postural; Defect
Study type: Interventional

Summary: 
      This randomized control trial examined the effects of postural education or corrective
      exercise intervention on the craniovertebral angle (CVA) in young adults with forward head
      posture (FHP). The objectives were 1: to investigate whether or not a corrective exercise
      program (CEP) consisting of self-myofascial release (SMR) + stretching; a CEP consisting of
      SMR + stretching + strengthening; or postural education (PE) had an effect on the CVA; 2. to
      determine which intervention yielded the greatest postural enhancement if a positive effect
      was observed in more than one intervention. *[note: SMR is a technique involving the
      self-application of pressure to fascia and muscle tissue for the purpose of enhancing
      flexibility, reducing muscle soreness, and influencing muscle relaxation]. It was
      hypothesized that 4 weeks after receiving either CEP intervention or PE there would be a
      significant change in the CVA compared to a control group; and that there would be an
      intervention more effective than the others for improving the CVA. The null hypotheses were:
      there would be no CVA change after intervention in any of the groups; and there will be no
      intervention more effective than another for improving the CVA.
    

Detailed description: 
      A total of 94 participants responded to invitations to voluntarily participate and completed
      the Physical Activity Readiness Questionnaire (PAR-Q+), followed by a questionnaire to rate
      their current stage of change (SOC) from the Transtheoretical Model adapted to assess
      exercise/postural modification behavior change (this will be discussed further in eligibility
      section). On this questionnaire, participants also responded to a yes/no question regarding
      if they have had a recent injury to their head, shoulders, or spine; or have ever been
      diagnosed with a pathology related to their cervical/thoracic spine or extremities, as part
      of exclusion criteria for the study. Participants then underwent a head posture screening
      performed by the primary investigator who is a licensed physical therapist in the Liberty
      University Biomechanics & Motion Analysis Laboratory with the use of photogrammetry (use of a
      digital camera and software to measure posture) as described below.

      Participants were asked to arrive at the lab wearing either a tank top or t-shirt, as well as
      to have their hair tied back if necessary. Height and weight were measured using a digital
      scale (Health-o-meter Professional, model 500KL, McCook, IL). Participants were instructed to
      sit comfortably on a stool with hands resting approximately two-thirds down their thighs with
      palms supinated and feet flat on the ground with hips and knees at 90 degrees; and to look
      straight ahead at an opposite wall in the laboratory. A digital camera (Canon Powershot,
      model SX540, Tokyo, Japan) was mounted and leveled on a tripod (Manfrotto, model 055,
      Cassola, IT) and placed three meters away from the subject. Two photographs were taken of
      participant's posture. Immediately after data capture, image files were uploaded into Kinovea
      video analysis software (version 8.15) for CVA assessment. CVA assessment will be discussed
      further in outcome measures section.

      Seventy-nine participants met inclusion criteria (discussed in detail in future section) and
      were enrolled in the study. Randomization of participant group assignments was completed by
      the PI using a block randomization generator. Utilizing a sequence created by the block
      randomizer, the PI placed participants who met inclusion criteria into one of four groups:
      postural education (PE; n = 20), self-myofascial release + stretching (SMRS; n = 20),
      self-myofascial release + stretching + strengthening (SMRSS; n = 19), and control group (CG;
      n = 20). Details of these groups will be provided in future sections. A hard-copy of the
      sequence generator report was kept concealed in a manila folder and was only opened by the PI
      during group delegation.

      Intervention duration was 4 weeks. Two weeks into the study, participants in intervention
      groups completed a mid-study questionnaire to assess intervention compliance. At the end of
      the study (after the completion of 4 weeks) participants in intervention groups completed a
      post-study questionnaire to assess intervention compliance. All study participants were asked
      to return back to the Biomechanics laboratory after the completion of the 4 week intervention
      period to undergo follow-up posture screening, which followed the same posture assessment
      procedures as described above.

      Declarations of interest: This study was part of the requirements for completion of a Ph.D.
      dissertation (Concordia University Chicago) by David Titcomb, DPT.

      Conflicts of interest: none.
    

Intervention name(s): Education for Behavior Modification; Corrective Exercise Program
Intervention type(s): Behavioral; Behavioral
Intervention description(s): Please see arm description for a detailed description of the intervention; Please see arm description for a detailed description of the intervention
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: A prospective parallel randomized controlled trial with repeated measures
Masking: None (Open Label)
Primary purpose: Prevention
Keywords: Forward Head Posture; Craniovertebral Angle; Corrective Exercise Program; Postural Education