An interventional study of Wearable postural biofeedback device and App based Postural Reminder in Forward Head Posture, sponsored by Riphah International University. Recruiting at 1 site in Pakistan. Open to participants aged 18 Years to 30 Years. Per ClinicalTrials.gov, last updated 2026-10-13.
Sponsored by Riphah International University · Not applicable, Interventional, and Treatment
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.
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.
Riphah International University is the lead sponsor of 2,193 studies on the registry; 650 are open to participants now.
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Exclusion Criteria:
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
Device: Wearable postural biofeedback device
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.
Behavioral: App based Postural Reminder
Participants will receive the standardized cervicothoracic exercise program alone over a 6 week intervention period, without any wearable device or app based reminder.
Other: Conventional Cervicothoracic Exercise Therapy
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.
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
A structured , supervised exercise program targeting cervicothoracic postural muscles , delivered without any wearable device or app based reminder
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.
Time frame: 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
Time frame: At Baseline , Mid treatment Intervention (4th week) , Post intervention (6th week) and follow up at 12 week
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
Time frame: 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
Time frame: 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.
Time frame: 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
Time frame: 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)
Time frame: At Baseline , Mid intervention (4th week) , Post Intervention (6th week) and follow up at 12 week
Intervention Adherence Rate
Session attendance, exercise completion rate, and app/wearable device usage recorded via attendance registers, digital app logs, and wearable device session records, depending on group assignment.
Time frame: At Baseline , Mid intervention (4th week) , Post Intervention (6th week) and follow up at 12 week.
Plan to share: 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.
From the registry record's own update history. This site started tracking changes on Sep 25, 2026; for anything earlier, see the record history on ClinicalTrials.gov ↗
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