{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T10:45:05Z","timestamp":1791456305786,"version":"4.3.4"},"reference-count":52,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JMIR Rehabil Assist Technol"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec sec-type=\"background\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Neck pain is a common musculoskeletal disorder, often linked to forward head posture (FHP). Studies have shown that exercise interventions can improve pain, craniovertebral angle (CVA), range of motion, and function in individuals with FHP. While telerehabilitation exercise has proven effective for other musculoskeletal conditions, its effectiveness in addressing neck pain and FHP is still being investigated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec sec-type=\"objective\">\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This study aimed to evaluate and compare the effectiveness of an internet-based telerehabilitation therapeutic exercise program with an in-person supervised program in improving clinical outcomes among young adult females with chronic nonspecific neck pain and FHP. The study hypothesized that there would be no significant differences in outcomes between the 2 groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec sec-type=\"methods\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A randomized controlled trial was conducted with 50 participants experiencing chronic neck pain and FHP, recruited through public announcement and voluntary sign-up. Participants were randomly assigned to either a telerehabilitation group or an in-person supervision group. Both groups completed the same 6-week, physiotherapist-supervised therapeutic exercise program, delivered via Zoom (Zoom Video Communications) or in the physiotherapy department laboratory, respectively. Outcome assessments were conducted face-to-face by blinded assessors at baseline, after 4 and 6 weeks of intervention, and at a 2-week follow-up. Outcome measures included pain intensity (assessed using the Visual Analog Scale [VAS]), CVA, neck disability (assessed using the Neck Disability Index [NDI]), and cervical range of motion (CROM). Adherence was monitored using attendance logs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec sec-type=\"results\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of the 50 participants, 48 completed the intervention with 1 dropout from each group. Adherence among completers was 100 percent in both groups. All 50 participants were included in the analysis using the intention-to-treat principle. No differences in effectiveness were found between the telerehabilitation and in-person groups, as no significant interaction effect between group and time was observed across all outcome measures including VAS, CVA, NDI, and CROM (\n                      <jats:italic>P<\/jats:italic>\n                      values ranged .07-.61). However, improvements were observed in all outcomes across time, including a 2.2\u2010 to 4.1-cm reduction in VAS, 5\u00b0-8.8\u00b0 increase in CVA, 3.3\u2010 to 7.1-point reduction in NDI (\n                      <jats:italic>P<\/jats:italic>\n                      &lt;.001 for all), and 3.5\u00b0-22.7\u00b0 increase in CROM (\n                      <jats:italic>P<\/jats:italic>\n                      &lt;.001 to\n                      <jats:italic>P<\/jats:italic>\n                      =.04).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec sec-type=\"conclusions\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Both telerehabilitation and in-person supervision were similarly effective in improving pain, posture, neck disability, and CROM in young adult females with chronic neck pain and FHP. These findings suggest that telerehabilitation may be a feasible and accessible alternative to conventional in-person therapeutic exercise programs for managing chronic neck pain with FHP.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2196\/74979","type":"journal-article","created":{"date-parts":[[2025,7,25]],"date-time":"2025-07-25T20:42:36Z","timestamp":1753476156000},"page":"e74979-e74979","source":"Crossref","is-referenced-by-count":10,"title":["Internet-Based Telerehabilitation Versus in-Person Therapeutic Exercises in Young Adult Females With Chronic Neck Pain and Forward Head Posture: Randomized Controlled Trial"],"prefix":"10.2196","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8723-9350","authenticated-orcid":false,"given":"Patcharin","family":"Nilmart","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-9794-6771","authenticated-orcid":false,"given":"Arrada","family":"Sichuai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-1945-8091","authenticated-orcid":false,"given":"Asree","family":"Chedang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-2580-1559","authenticated-orcid":false,"given":"Chanikarn","family":"Goontharo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-9165-0273","authenticated-orcid":false,"given":"Nollapan","family":"Janjamsai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2025,7,25]]},"reference":[{"key":"R1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.m791","article-title":"Global, regional, and national burden of neck pain in the general population, 1990-2017: systematic analysis of the Global Burden of Disease Study 2017","volume":"368","author":"Safiri","journal-title":"BMJ"},{"issue":"6","key":"R2","doi-asserted-by":"publisher","first-page":"834","DOI":"10.1007\/s00586-004-0864-4","article-title":"The prevalence of neck pain in the world population: a systematic critical review of the literature","volume":"15","author":"Fejer","journal-title":"Eur Spine J"},{"issue":"3","key":"R3","doi-asserted-by":"publisher","DOI":"10.1093\/ptj\/pzab007","article-title":"Is neck posture subgroup in late adolescence a risk factor for persistent neck pain in young adults? A prospective study","volume":"101","author":"Richards","journal-title":"Phys Ther"},{"issue":"6","key":"R4","doi-asserted-by":"publisher","first-page":"656","DOI":"10.1001\/jama.299.6.656","article-title":"Expenditures and health status among adults with back and neck problems","volume":"299","author":"Martin","journal-title":"JAMA"},{"issue":"2","key":"R5","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1142\/S1013702518300010","article-title":"Musculoskeletal disorder and pain associated with smartphone use: a systematic review of biomechanical evidence","volume":"38","author":"Eitivipart","journal-title":"Hong Kong Physiother J"},{"issue":"5","key":"R6","doi-asserted-by":"publisher","first-page":"457","DOI":"10.1016\/j.math.2010.03.009","article-title":"Relationships between sagittal postures of thoracic and cervical spine, presence of neck pain, neck pain severity and disability","volume":"15","author":"Lau","journal-title":"Man Ther"},{"issue":"3","key":"R7","doi-asserted-by":"publisher","first-page":"371","DOI":"10.1007\/s43465-023-00820-x","article-title":"Is neck pain related to sagittal head and neck posture?: A systematic review and meta-analysis","volume":"57","author":"Rani","journal-title":"Indian J Orthop"},{"issue":"1","key":"R8","doi-asserted-by":"publisher","first-page":"75","DOI":"10.1016\/s0003-6870(01)00043-6","article-title":"A field comparison of neck and shoulder postures in symptomatic and asymptomatic office workers","volume":"33","author":"Szeto","journal-title":"Appl Ergon"},{"issue":"2","key":"R9","doi-asserted-by":"publisher","first-page":"131","DOI":"10.3233\/BMR-130426","article-title":"Assessment of forward head posture in females: observational and photogrammetry methods","volume":"27","author":"Salahzadeh","journal-title":"J Back Musculoskelet Rehabil"},{"key":"R10","doi-asserted-by":"publisher","DOI":"10.1016\/j.jelekin.2016.05.007","article-title":"Effects of suboccipital release with craniocervical flexion exercise on craniocervical alignment and extrinsic cervical muscle activity in subjects with forward head posture","volume":"30","author":"Kim","journal-title":"J Electromyogr Kinesiol"},{"issue":"19","key":"R11","doi-asserted-by":"publisher","first-page":"2108","DOI":"10.1097\/01.brs.0000141170.89317.0e","article-title":"Patients with neck pain demonstrate reduced electromyographic activity of the deep cervical flexor muscles during performance of the craniocervical flexion test","volume":"29","author":"Falla","journal-title":"Spine (Phila Pa 1986)"},{"issue":"6","key":"R12","doi-asserted-by":"publisher","first-page":"1669","DOI":"10.1589\/jpts.28.1669","article-title":"Effect of duration of smartphone use on muscle fatigue and pain caused by forward head posture in adults","volume":"28","author":"Kim","journal-title":"J Phys Ther Sci"},{"issue":"2","key":"R13","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1023\/a:1015008513575","article-title":"A study on the prevalence of and risk factors for neck pain among university academic staff in Hong Kong","volume":"12","author":"Chiu","journal-title":"J Occup Rehabil"},{"issue":"5","key":"R14","doi-asserted-by":"publisher","first-page":"640","DOI":"10.1123\/jsr.2021-0381","article-title":"Evidence-based corrective exercise intervention for forward head posture in adolescents and young adults without musculoskeletal pathology: a critically appraised topic","volume":"31","author":"Titcomb","journal-title":"J Sport Rehabil"},{"issue":"1","key":"R15","doi-asserted-by":"publisher","DOI":"10.1186\/s12891-019-2438-y","article-title":"The effect of manual therapy and stabilizing exercises on forward head and rounded shoulder postures: a six-week intervention with a one-month follow-up study","volume":"20","author":"Fathollahnejad","journal-title":"BMC Musculoskelet Disord"},{"issue":"3","key":"R16","doi-asserted-by":"publisher","first-page":"291","DOI":"10.5606\/tftrd.2021.6397","article-title":"Effects of a combination of scapular stabilization and thoracic extension exercises for office workers with forward head posture on the craniovertebral angle, respiration, pain, and disability: A randomized-controlled trial","volume":"67","author":"Kang","journal-title":"Turk J Phys Med Rehabil"},{"issue":"6","key":"R17","doi-asserted-by":"publisher","DOI":"10.1093\/ptj\/pzab053","article-title":"Effectiveness of telerehabilitation in physical therapy: a rapid overview","volume":"101","author":"Seron","journal-title":"Phys Ther"},{"issue":"3","key":"R18","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph20032233","article-title":"Comparison of functional outcomes between supervised rehabilitation and telerehabilitation in female patients with patellofemoral pain syndrome during the COVID-19 pandemic","volume":"20","author":"Lee","journal-title":"Int J Environ Res Public Health"},{"key":"R19","doi-asserted-by":"publisher","DOI":"10.2196\/72466","article-title":"The effectiveness of telerehabilitation in managing pain, strength, and balance in adult patients with knee osteoarthritis: systematic review","volume":"12","author":"Plavoukou","journal-title":"JMIR Rehabil Assist Technol"},{"issue":"10","key":"R20","doi-asserted-by":"publisher","first-page":"1924","DOI":"10.1016\/j.apmr.2022.04.016","article-title":"Outcomes of telehealth physical therapy provided using real-time, videoconferencing for patients with chronic low back pain: a longitudinal observational study","volume":"103","author":"Fritz","journal-title":"Arch Phys Med Rehabil"},{"issue":"1","key":"R21","doi-asserted-by":"publisher","DOI":"10.2196\/21107","article-title":"Health-enabling technologies to assist patients with musculoskeletal shoulder disorders when exercising at home: scoping review","volume":"8","author":"Elgert","journal-title":"JMIR Rehabil Assist Technol"},{"issue":"3","key":"R22","doi-asserted-by":"publisher","DOI":"10.2196\/36028","article-title":"Real-time telerehabilitation in older adults with musculoskeletal conditions: systematic review and meta-analysis","volume":"9","author":"Jirasakulsuk","journal-title":"JMIR Rehabil Assist Technol"},{"issue":"3","key":"R23","doi-asserted-by":"publisher","first-page":"269","DOI":"10.1080\/14737175.2023.2192870","article-title":"Effects of spinal stabilization exercises delivered using telerehabilitation on outcomes in patients with chronic neck pain: a randomized controlled trial","volume":"23","author":"Onan","journal-title":"Expert Rev Neurother"},{"issue":"5","key":"R24","doi-asserted-by":"publisher","first-page":"823","DOI":"10.1177\/1357633X221095782","article-title":"The effectiveness of telerehabilitation-based structured exercise therapy for chronic nonspecific neck pain: a randomized controlled trial","volume":"30","author":"\u00d6zel","journal-title":"J Telemed Telecare"},{"issue":"4","key":"R25","doi-asserted-by":"publisher","DOI":"10.2196\/jmir.1923","article-title":"CONSORT-EHEALTH: improving and standardizing evaluation reports of Web-based and mobile health interventions","volume":"13","author":"Eysenbach","journal-title":"J Med Internet Res"},{"issue":"4","key":"R26","doi-asserted-by":"publisher","first-page":"351","DOI":"10.1177\/0269215511419536","article-title":"The efficacy of forward head correction on nerve root function and pain in cervical spondylotic radiculopathy: a randomized trial","volume":"26","author":"Diab","journal-title":"Clin Rehabil"},{"issue":"3","key":"R27","doi-asserted-by":"publisher","first-page":"281","DOI":"10.1007\/s00420-019-01480-x","article-title":"Effect of therapeutic exercise routine on pain, disability, posture, and health status in dentists with chronic neck pain: a randomized controlled trial","volume":"93","author":"Letafatkar","journal-title":"Int Arch Occup Environ Health"},{"issue":"2","key":"R28","doi-asserted-by":"publisher","first-page":"132","DOI":"10.1097\/AJP.0000000000000999","article-title":"A systematic review and synthesis of psychometric properties of the numeric pain rating scale and the visual analog scale for use in people with neck pain","volume":"38","author":"Modarresi","journal-title":"Clin J Pain"},{"issue":"7","key":"R29","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph18073410","article-title":"Effect of 4 weeks of cervical deep muscle flexion exercise on headache and sleep disorder in patients with tension headache and forward head posture","volume":"18","author":"Choi","journal-title":"Int J Environ Res Public Health"},{"issue":"5","key":"R30","first-page":"681","volume":"95","author":"Luksanapruksa","journal-title":"J Med Assoc Thai"},{"issue":"10","key":"R31","doi-asserted-by":"publisher","first-page":"640","DOI":"10.2519\/jospt.2008.2680","article-title":"Intrarater reliability of CROM measurement of cervical spine active range of motion in persons with and without neck pain","volume":"38","author":"Fletcher","journal-title":"J Orthop Sports Phys Ther"},{"issue":"1","key":"R32","doi-asserted-by":"publisher","first-page":"954","DOI":"10.70252\/PYPQ8483","article-title":"The effects of postural education or corrective exercise on the craniovertebral angle in young adults with forward head posture: a randomized controlled trial","volume":"16","author":"Titcomb","journal-title":"Int J Exerc Sci"},{"issue":"1","key":"R33","doi-asserted-by":"publisher","DOI":"10.1186\/s13063-021-05875-5","article-title":"Online supervised versus workplace corrective exercises for upper crossed syndrome: a protocol for a randomized controlled trial","volume":"22","author":"Yaghoubitajani","journal-title":"Trials"},{"key":"R34","doi-asserted-by":"publisher","DOI":"10.12659\/MSM.920208","article-title":"Effects of lower trapezius strengthening exercises on pain, dysfunction, posture alignment, muscle thickness and contraction rate in patients with neck pain; randomized controlled trial","volume":"26","author":"Park","journal-title":"Med Sci Monit"},{"issue":"2","key":"R35","doi-asserted-by":"publisher","first-page":"419","DOI":"10.1016\/j.pmr.2020.12.005","article-title":"Virtual physical therapy and telerehabilitation","volume":"32","author":"Havran","journal-title":"Phys Med Rehabil Clin N Am"},{"issue":"3","key":"R36","doi-asserted-by":"publisher","first-page":"398","DOI":"10.1589\/jpts.30.398","article-title":"Effect of interferential current therapy on forward head posture","volume":"30","author":"Choi","journal-title":"J Phys Ther Sci"},{"issue":"3","key":"R37","doi-asserted-by":"publisher","first-page":"253","DOI":"10.1007\/s00421-008-0696-8","article-title":"Alterations in cervical muscle activity in functional and stressful tasks in female office workers with neck pain","volume":"103","author":"Johnston","journal-title":"Eur J Appl Physiol"},{"issue":"1","key":"R38","doi-asserted-by":"publisher","DOI":"10.1155\/2021\/7190808","article-title":"Efficacy of deep cervical flexor muscle training on neck pain, functional disability, and muscle endurance in school teachers: a clinical trial","volume":"2021","author":"Iqbal","journal-title":"Biomed Res Int"},{"issue":"6","key":"R39","doi-asserted-by":"publisher","first-page":"530","DOI":"10.1016\/j.jmpt.2018.02.002","article-title":"Effectiveness of therapeutic exercise on forward head posture: a systematic review and meta-analysis","volume":"41","author":"Sheikhhoseini","journal-title":"J Manipulative Physiol Ther"},{"issue":"3","key":"R40","doi-asserted-by":"publisher","first-page":"227","DOI":"10.3171\/2017.5.SPINE1732","article-title":"Validation of the visual analog scale in the cervical spine","volume":"28","author":"MacDowall","journal-title":"J Neurosurg Spine"},{"issue":"12","key":"R41","doi-asserted-by":"publisher","DOI":"10.1016\/j.isci.2023.108543","article-title":"Effects of online exercise intervention on physical and mental conditions in young adults with chronic neck pain","volume":"26","author":"Lin","journal-title":"iScience"},{"issue":"4","key":"R42","doi-asserted-by":"publisher","first-page":"235","DOI":"10.1016\/s0004-9514(14)60412-8","article-title":"Active stabilisation training for screen based keyboard operators - a single case study","volume":"43","author":"Grant","journal-title":"Aust J Physiother"},{"issue":"4","key":"R43","doi-asserted-by":"publisher","first-page":"408","DOI":"10.2522\/ptj.20060009","article-title":"Effect of neck exercise on sitting posture in patients with chronic neck pain","volume":"87","author":"Falla","journal-title":"Phys Ther"},{"issue":"6","key":"R44","doi-asserted-by":"publisher","first-page":"804","DOI":"10.1589\/jpts.30.804","article-title":"Effect of scapular stabilization exercise on neck alignment and muscle activity in patients with forward head posture","volume":"30","author":"Kang","journal-title":"J Phys Ther Sci"},{"issue":"7","key":"R45","doi-asserted-by":"publisher","first-page":"2009","DOI":"10.1589\/jpts.28.2009","article-title":"Clinical effectiveness of a pilates treatment for forward head posture","volume":"28","author":"Lee","journal-title":"J Phys Ther Sci"},{"issue":"1","key":"R46","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.jmpt.2016.10.005","article-title":"Effects of a resistance and stretching training program on forward head and protracted shoulder posture in adolescents","volume":"40","author":"Ruivo","journal-title":"J Manipulative Physiol Ther"},{"issue":"5","key":"R47","doi-asserted-by":"publisher","first-page":"400","DOI":"10.2519\/jospt.2009.2930","article-title":"Measurement properties of the neck disability index: a systematic review","volume":"39","author":"MacDermid","journal-title":"J Orthop Sports Phys Ther"},{"issue":"1","key":"R48","doi-asserted-by":"publisher","DOI":"10.1186\/s13063-020-04610-w","article-title":"Manual therapy versus therapeutic exercise in non-specific chronic neck pain: a randomized controlled trial","volume":"21","author":"Bernal-Utrera","journal-title":"Trials"},{"issue":"1","key":"R49","doi-asserted-by":"publisher","DOI":"10.1186\/s12891-017-1889-2","article-title":"Upper thoracic spine mobilization and mobility exercise versus upper cervical spine mobilization and stabilization exercise in individuals with forward head posture: a randomized clinical trial","volume":"18","author":"Cho","journal-title":"BMC Musculoskelet Disord"},{"issue":"7","key":"R50","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.27160","article-title":"Effects of cervical spine exercise protocol on neck pain, pericervical muscle endurance, and range of motion in medical students: a prospective study","volume":"14","author":"Anderson","journal-title":"Cureus"},{"issue":"1","key":"R51","doi-asserted-by":"publisher","DOI":"10.5195\/ijt.2021.6334","article-title":"Telerehabilitation in Italy during the COVID-19 lockdown: a feasibility and acceptability study","volume":"13","author":"Milani","journal-title":"Int J Telerehabil"},{"issue":"9","key":"R52","doi-asserted-by":"publisher","first-page":"1258","DOI":"10.1177\/0269215518771820","article-title":"Patient and therapist experiences of using affordable feedback-based technology in rehabilitation: a qualitative study nested in a randomized controlled trial","volume":"32","author":"Hamilton","journal-title":"Clin Rehabil"}],"container-title":["JMIR Rehabilitation and Assistive Technologies"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/rehab.jmir.org\/2025\/1\/e74979","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T18:05:47Z","timestamp":1782842747000},"score":1,"resource":{"primary":{"URL":"https:\/\/rehab.jmir.org\/2025\/1\/e74979"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,25]]},"references-count":52,"URL":"https:\/\/doi.org\/10.2196\/74979","relation":{},"ISSN":["2369-2529"],"issn-type":[{"value":"2369-2529","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7,25]]},"article-number":"v12i6e74979"}}