Effect of Postural Realignment on Postural Stability and Visual Reliance in Older Adults

Study Overview
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Brief Summary
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The purpose of this investigator-initiated study is 1) to investigate correlation between cervical spine joint position error (JPE) and postural stability in asymptomatic older adults with forward head posture (FHP), 2) to examine the effect of a home-based exercise program on visual reliance and cervical spine proprioception for postural stability in asymptomatic older adults with FHP, 3) to study the effect of immediate postural correction on cervical spine JPE and active range of motion (AROM), and 4) to determine participant post-intervention perception of changes in FHP, postural stability and effect on quality of life.

Detailed Description
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This study will have a sample size of 50 older adults (males and females) aged 65-74 years old with FHP. This sample size will provide us with enough power to detect the needed effect size (medium effect size). The estimated attrition rate is 20%. The participants will be recruited from the local community through flyers, e-mails, and word of mouth. Study flyers will be delivered to physical therapy clinics, physician offices, and support groups with verbal description for further explanations. Potential participants who respond to the emails or flyers will be provided with a verbal description of the study. The study will be conducted in the Department of Physical Therapy, Loma Linda University, Loma Linda. Hard copies will be stored in a locked file cabinet in a locked research laboratory and computer data will be stored on an encrypted computer in a locked research laboratory. All data will be analyzed using Statistical Package for the Social Sciences (SPSS) version 27.0. For quantitative data, the investigators will use the General Linear Model (Mixed Factorial Analysis of Variance) and Correlation Analysis (Pearson's Correlation). Also, a statistician will be consulted to accurately analyze and interpret results. The alpha level will be set at 0.05. Efforts will be made to keep participants' personal information confidential, but the investigators cannot guarantee absolute confidentiality. The investigators will use a pseudonym throughout the study for all recorded data so participant's actual name will not be used. Participants will not be identified by name in any publications describing the results of this study. Data in hard copy will be kept in a locked file cabinet in a locked office and electronic data will be password protected.

Official Title
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Effect of Home-based Exercise Program on Visual Reliance, Cervical Spine Proprioception, and Postural Stability in Older Adults With Forward Head Posture

Conditions
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Forward Head Posture

Intervention / Treatment
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* Other: Home-based Exercise Program


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Older adults aged 65-74 years with forward head posture (FHP) Live independently No use of assistive devices for ambulation Have interest in correcting misaligned posture Normal Physical Activity Readiness Questionnaire (PAR-Q+) Exclusion Criteria: Neurologic deficits Disorders causing dizziness Cervical spine surgery Any falls in past six months Medications causing frequent dizziness Any health care for neck, shoulder, or low back pain past 12 months Greater than minimal neck pain as determined by the Visual Analogue Scale (VAS) > 3/10 Neck Disability Index (NDI) > 15% Forward Head Angle (FHA) < 46 degrees Forward Shoulder Angle (FSA) < 52 degrees

Ages Eligible for Study
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Minimum Age: 65 Years
Maximum Age: 74 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Intervention Model: Single Group Assignment
Interventional Model Description: single group pretest-posttest design
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Single group<br>The study will include one group and each participant will perform home-based exercise for 8-weeks. | Other: Home-based Exercise Program<br>* The exercise program will include chink tuck and shoulder retraction exercises. The chin tuck exercise will be performed in standing position. The shoulder retraction exercise includes activation and strengthening components. The activation component will be performed in standing position and strengthening component will be performed in prone position.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in Cervical Joint Position Error (JPE) | Ability to relocate one's head and neck to pre-determined neutral position recorded in degrees. | JPE will be measured twice (pre vs post-intervention) and each time will take approximately 25-30 minutes. | 
| Change in Active Cervical Spine Range of Motion (AROM) | Ability to actively move cervical spine in all six directions (flexion, extension, right and left rotation, right and left Lateral flexion). Cervical AROM will be measured in degrees. | AROM will be measured twice (pre vs post-intervention) and each time will take approximately 5 minutes | 
| Change in Postural Stability | Ability to keep center of gravity within base of support under six different testing conditions and will be scored from 0-100 by the computer software. Higher scores indicate better postural stability. | Postural stability will be measured twice (pre vs post-intervention) and each time will take approximately 25 minutes | 
| Change in Forward Head Angle (FHA) | FHA is the angle formed between a line extending from the tragus to C7 and a vertical axis at C7. FHA will be measured in degrees. | FHA will be measured twice (pre vs post-intervention) and each time will take approximately 13 minutes. | 
| Change in Forward Shoulder Angle (FSA) | FSA is the angle between a line extending from C7 to acromion and the vertical axis at C7. FSA will be measured in degrees. | FSA will be measured twice (pre vs post-intervention) and each time will take approximately 13 minutes. | 
| Post-Intervention Structured Interview | Post-intervention structured interview will be conducted using open-ended questions. Interviews will be recorded and transcribed verbatim. Transcriptions will be individually coded, and then group coded using qualitative research software. | 20-25 minutes | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in Balance Confidence | Subjective confidence in performing functional activities without losing balance. Activities-Specific Balance Confidence (ABC-6) scale will be used to measure balance confidence. ABC-6 scale ranges from 0 to 100 where 0 represents no confidence and 100 represents complete confidence. | ABC-6 will be conducted twice (pre vs post-intervention) and each time will take approximately 5 minutes. | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Forward head posture, Balance, Home exercise program