Forward Head PostureNCT07763327
Effects of a Wearable Device ,Phone App and Exercise on Cervico-thoracic Posture in University Students.
A study testing Wearable postural biofeedback device, App based Postural Reminder and Conventional Cervicothoracic Exercise Therapy in people with Forward Head Posture, run by Riphah International University at 1 site in Pakistan.
Trial summary
Forward head posture and thoracic kyphosis are among the most common postural problems in university students, driven largely by long hours of screen use and poor sitting habits. Read more about this study
- Who is it for?
- Ages 18 to 30 years
- Conditions the study is for
- Forward Head Posture
- What is being tested?
- Wearable postural biofeedback device, App based Postural Reminder and Conventional Cervicothoracic Exercise Therapy
- Type of treatment
- Medical device, Lifestyle or therapy programme
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 87 participants
- Where
- 1 sitePakistan
- Study dates
- 14 Sep 2026to 31 May 2027
- Phase
- Interventional
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 to 30 years
- All sexes
- No healthy volunteers
- Adult
Who may be able to join
- University students aged 18-30 years enrolled in a degree program at Riphah International University.
- Daily sitting duration ≥ 5 hours (academic and/or device-related activities).
- Presence of at least one observable postural deviation confirmed at baseline assessment: forward head posture (CVA < 50°), rounded shoulders (protracted shoulder distance in supine line), or thoracic kyphosis (> 40° via digital inclinometer).
- Smartphone ownership and basic digital literacy
Who cannot join
- History of spinal surgery, vertebral fracture, or major cervical/thoracic trauma within the past 12 months.
- Diagnosed neurological disorders affecting posture or motor control (e.g., Parkinson's disease, stroke, cervical dystonia).
- Structural spinal deformities requiring active medical or surgical management (e.g., scoliosis Cobb angle > 20°, Scheuermann's kyphosis).
- Current participation in physiotherapy, chiropractic treatment, or another structured posture correction program.
- Cardiovascular or pulmonary conditions contraindicating moderate-intensity exercise (e.g., uncontrolled hypertension, severe asthma).
- Skin conditions, open wounds, or allergies precluding safe use of the posture correction belt.
Trial locations and contacts
1 site in 1 country. Contact the study team or a site near you to ask about taking part.
Pakistan1 site, 1 recruiting
- Recruiting
Postgraduation Lab of Riphah College of Rehabilitation & Allied Health Sciences , Riphah International University. Islamabad
Islamabad, 44000
Aliha Batool, Dpt, 03145967336, alihabatool006@gmail.com
Huma Riaz, PhD
About this study
Official title: Comparison of Wearable Device -Based , App- Based ,and Conventional Exercise Therapy for Cervico-Thoracic Postural Training in University Students.
Forward head posture and thoracic kyphosis are among the most common postural problems in university students, driven largely by long hours of screen use and poor sitting habits. Research suggests that nearly two-thirds of university students show measurable forward head posture, and if uncorrected, it is linked to chronic neck pain and long-term musculoskeletal strain. This study compares three approaches to correcting posture over a six-week supervised exercise program: a wearable sensor belt that vibrates in real time when posture slips, a smartphone app that sends scheduled reminders throughout the day, and exercise alone with no reminders. The two technology-assisted groups are prompted to correct their posture throughout daily activities, not just during exercise sessions. The study will show whether real-time or scheduled reminders produce greater improvements in posture, neck pain, and neck function than exercise alone . Helping physical therapists and university health services to identify the most practical strategy for correcting posture in screen-heavy academic environments.
Read the detailed description
Forward head posture(FHP) and thoracic kyphosis are increasingly prevalent among university students due to sustained flexed-neck postures during smartphone use, laptop-based study, and prolonged sitting. Chronic FHP alters the normal cervical lordotic curve, increases mechanical loading on cervical spine structures, and has been associated with muscular imbalance, cervicogenic pain , and headache.
Conventional postural correction exercise programs are well established, but adherence to postural correction outside of supervised sessions remains a key limitation. Students are typically unaware of their posture lapsing during daily activities such as studying, phone use and prolonged sitting and correction cues are usually absent outside the clinical or exercise setting.
Technology-assisted feedback systems have emerged as a potential solution to this adherence gap. Wearable biofeedback devices provide immediate, real-time correction cues when a threshold postural deviation is detected, theoretically reinforcing correct postural habits through continuous behavioral conditioning. App-based reminder systems, offers a scheduled, intermittent prompts rather than continuous monitoring , it is more practical and scalable given lower cost and no specialized hardware requirement.
This three arm, parallel group randomized controlled trial is designed to generate comparative evidence on the relative effectiveness of continuous biofeedback, scheduled reminders, and conventional exercise therapy alone, in order to inform evidence-based, resource-appropriate postural correction strategies for university and academic health settings.
The results of this trial are intended to directly inform clinical decision-making for physiotherapists and university wellness programs considering adoption of wearable or app-based postural correction tools. Should either technology-assisted approach demonstrate superiority over conventional exercise alone, this would support integration of low-cost, scalable postural feedback technology into standard student musculoskeletal health programs. Conversely, if outcomes are comparable across groups, this would support conventional supervised exercise as a sufficient, lower-cost first-line approach, without the added expense or complexity of technology-assisted feedback devices.
University students represent a population with high daily screen-time exposure and sedentary study behavior, making them broadly representative of the wider demographic at risk for posture-related cervical musculoskeletal strain seen in academic and early-career professional environments. Evidence generated from this population is expected to have relevance beyond the immediate study setting, informing postural health strategies applicable to similarly screen-intensive occupational and educational contexts.
- Conditions
- Forward Head Posture
- Being tested
- Wearable postural biofeedback device, App based Postural Reminder, Conventional Cervicothoracic Exercise Therapy
- Keywords
- forward head posture , thoracic kyphosis , Craniovertebral angle , Posture Correction , Neck Disability , University Students
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Wearable postural biofeedback deviceDevice
A wearable belt worn around the cervicothoracic region that detects postural deviation in real time and provide vibratory feedback to prompt immediate self-correction , used in conjunction with standardized exercise program.
App based Postural ReminderBehavioural
A smartphone application that delivers scheduled reminders prompting participants to self-check and correct their posture throughout the day, used in conjunction with the standardized exercise program
Conventional Cervicothoracic Exercise TherapyOther
A structured , supervised exercise program targeting cervicothoracic postural muscles , delivered without any wearable device or app based reminder
| Study group | Role | What they receive |
|---|---|---|
| Wearable Device + Exercise | Experimental | Participants will receive a wearable biofeedback belt that provides real time vibration feedback upon postural deviation, in addition to the standardized cervicothoracic exercise program administered to all groups , over a 6 week intervention period Receives: Device: Wearable postural biofeedback device |
| App- based Reminder + Exercise | Experimental | Participants will receive scheduled posture-check reminders via a smartphone application, in addition to the standardized cervicothoracic exercise program administered to all groups , over a 6 week intervention period. Receives: Behavioral: App based Postural Reminder |
| Conventional Exercise Therapy | Active comparator | Participants will receive the standardized cervicothoracic exercise program alone over a 6 week intervention period, without any wearable device or app based reminder. Receives: Other: Conventional Cervicothoracic Exercise Therapy |
What is being measured
The primary outcome is the main question the study is designed to answer.
Change in Craniovertebral angle
Degree of forward head posture measured via photogrammetry app, Calculated as angle between a horizontal line through C7 and a line to tragus of the ear. Normal CVA is greater than 50 degrees.
Measured: baseline ,Mid treatment (4th week) , Post intervention (6th week) and follow up (12th week)
Thoracic Kyphosis Angle
Degree of thoracic spinal curvature (T1 - T12) measured using a digital inclinometer. Normal range 20 degree to 45 degree
Measured: At Baseline , Mid treatment Intervention (4th week) , Post intervention (6th week) and follow up at 12 week
Secondary outcomes (5)
Change in Neck Disability Index Score
10 item self report questionnaire assessing functional disability related neck pain . Score converted to percentage ,higher score means greater disability. Excellent test re test reliability ,ICC score of 0.91
Measured: At Baseline , Mid intervention (4th week) , Post Intervention (6th week ) and follow up at 12th week
Change in Neck and Upper Back Pain Intensity
Subjective pain intensity rated on NPRS ,an 11-point scale (0 = no pain, 10 = worst pain imaginable).The test retest reliability range from 0.67 - 0.96
Measured: At Baseline , Mid intervention (4th week) , Post Intervention (6th week) and follow up at 12 week.
Change in Shoulder Protraction Distance
Horizontal distance from the posterolateral acromion to a table surface, measured with participant supine (Table Top Test). Distance greater than 2.6 cm indicates protracted shoulder posture.
Measured: At Baseline , Mid intervention (4th week) , Post Intervention (6th week) and follow up at 12 week.
Change in Postural Awareness Scale Score.
12-item validated self-report questionnaire assessing postural awareness and body perception, scored 12-60. Higher scores indicate better awareness. The test retest reliability value (ICC) is 0.75-0.83
Measured: At Baseline , Mid intervention (4th week) , Post Intervention (6th week) and follow up at 12 week
Change in Deep Neck Flexor Muscle Endurance
Endurance capacity of deep cervical flexor muscles (longus colli, longus capitis), measured in seconds using the Deep Neck Flexor Endurance Test. With good Intra rater Reliability (ICC= 0.81 - 0.94)
Measured: At Baseline , Mid intervention (4th week) , Post Intervention (6th week) and follow up at 12 week
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted13 Aug 2026
- Study start14 Sep 2026
- Primary completion30 May 2027 (estimated)
- Study completion31 May 2027 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (5)Papers the sponsor has linked to this study.
- Other trials for Forward Head PostureStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Model description
- Participants will be randomly allocated in a 1:1:1 to one of the three parallel groups: wearable biofeedback device plus exercise , App based reminder plus exercise and Conventional Exercise group. Each group will receive its assigned intervention independently over a six week period and than a follow up after 12 weeks, with no crossover between groups.
- Masking
- Single blind
- Who is masked
- Outcomes assessor
- Enrolment
- 87 participants (estimated)
Sponsor and investigators
- Lead sponsor
- Riphah International University
- Sponsor type
- University, hospital or other
- Responsible party
- Sponsor
- Investigators
- Huma Riaz, PhD, Principal investigator, Riphah International University, Islamabad
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT07763327
- Sponsor's protocol ID
- Aliha Batool
- Status last verified
- Oct 2026
- First submitted
- 10 Aug 2026
- Last updated
- 13 Oct 2026
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No: No formal data sharing infrastructure exists for this single site academic thesis study. De-identified individual participant data may be shared upon reasonable request to the corresponding investigator , subject to institutional approval from Riphah International University.
Publications
Nilmart P, Sichuai A, Chedang A, Goontharo C, Janjamsai N. Internet-Based Telerehabilitation Versus in-Person Therapeutic Exercises in Young Adult Females With Chronic Neck Pain and Forward Head Posture: Randomized Controlled Trial. JMIR Rehabil Assist Technol. 2025 Jul 25;12:e74979. doi: 10.2196/74979.
PubMed 40712139Anwar S, Zahid J, Alexe CI, Ghazi A, Mares G, Sheraz Z, Sanchez-Gomez R, Perveen W, Alexe DI, Gasibat Q. Effects of Myofascial Release Technique along with Cognitive Behavior Therapy in University Students with Chronic Neck Pain and Forward Head Posture: A Randomized Clinical Trial. Behav Sci (Basel). 2024 Mar 4;14(3):205. doi: 10.3390/bs14030205.
PubMed 38540507Singla D, Veqar Z. Association Between Forward Head, Rounded Shoulders, and Increased Thoracic Kyphosis: A Review of the Literature. J Chiropr Med. 2017 Sep;16(3):220-229. doi: 10.1016/j.jcm.2017.03.004. Epub 2017 Sep 28.
PubMed 29097952Kuo YL, Huang KY, Kao CY, Tsai YJ. Sitting Posture during Prolonged Computer Typing with and without a Wearable Biofeedback Sensor. Int J Environ Res Public Health. 2021 May 19;18(10):5430. doi: 10.3390/ijerph18105430.
PubMed 34069579Titcomb DA, Melton BF, Miyashita T, Bland HW. The Effects of Postural Education or Corrective Exercise on the Craniovertebral Angle in Young Adults with Forward Head Posture: A Randomized Controlled Trial. Int J Exerc Sci. 2023 Aug 1;16(1):954-973. doi: 10.70252/PYPQ8483. eCollection 2023.
PubMed 37649869