Neck PainNCT07102199
Effect of Attentional Focus Order in Home Exercise for Neck Pain
A study testing Internal focus of attention instructions- First, External focus of attention instructions- First and Home exercises in people with Neck Pain and Motor Learning, run by Büşra Tamgüç at 1 site in Turkey (Türkiye).
Trial summary
According to the International Association for the Study of Pain's 2017 terminology, neck pain is described as an unpleasant sensory and emotional experience originating in the cervical region and potentially radiating toward the scapular area, typically linked to actual or potential tissue injury. Read more about this study
- Who is it for?
- Ages 18 to 40 years
- Conditions the study is for
- Neck Pain, Motor Learning, Home Exercise Program
- What is being tested?
- Internal focus of attention instructions- First, External focus of attention instructions- First and Home exercises
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 39 participants
- Where
- 1 siteTurkey (Türkiye)
- Study dates
- 1 May 2025to 31 Dec 2025
- Phase
- Interventional
- Are there results?
- Not yet: the study is under way
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 40 years
- All sexes
- No healthy volunteers
- Adult
Who may be able to join
- Aged between 18 and 40 years
- A craniovertebral angle of 53 degrees or less
- A Visual Analog Scale score greater than 3 for pain in the neck and shoulder areas
- Experiencing head and neck pain for a duration exceeding three months
- A Neck Disability Index score ranging from 5 to 24
- A positive result on the cervical flexion-rotation test
- A body mass index within the range of 18.5 to 25 kg/m²
- No history of injury to the neck, trunk, or upper and lower extremities in the past six months
Who cannot join
- A positive result on the Spurling test
- Reduced or absent reflex responses in the upper extremities,
- Referred pain scoring greater than 7 on the Visual Analog Scale in the affected dermatome
- Diagnosis of cervical spinal stenosis
- Diagnosis of an autoimmune disorder
- Previous surgical intervention in the cervical or shoulder region
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- A positive result on the Vertebrobasilar insufficiency test
- Presence of any musculoskeletal deformity or abnormality
- Inability to carry out functional activities due to visual, auditory, vestibular, or neurological impairments
- Neck pain associated with malignancy or structural abnormalities
- Clinical presentation consistent with a capsular pattern suggestive of arthritis, or the presence of a severe psychological disorder
- Current pregnancy
- Participation in any form of exercise-based treatment or physiotherapy within the last three months
Trial locations and contacts
1 site in 1 country.
Turkey (Türkiye)1 site
İstanbul Nişantaşı University
Istanbul, Sarıyer
About this study
Official title: Effectiveness of Differently Sequenced Attentional Focus Instructions in a Home Exercise Program for Non-Specific Neck Pain: A Randomized Controlled Single-Blind Trial
According to the International Association for the Study of Pain's 2017 terminology, neck pain is described as an unpleasant sensory and emotional experience originating in the cervical region and potentially radiating toward the scapular area, typically linked to actual or potential tissue injury. Although research on how attentional focus instructions influence postural control remains limited, existing findings suggest that the sequence in which these instructions are delivered can impact sensory processing during postural control assessments. These observations raise compelling questions about the potential benefits of using attentional focus strategies in a structured, sequential manner during neck pain treatment. To date, however, no study has investigated how varying the order of attentional focus cues within a home exercise program affects individuals with non-specific neck pain. This study aimed to fill that gap by evaluating the clinical effectiveness of a home-based exercise protocol utilizing attentional focus instructions in different sequences. The primary outcome was disability level, measured by the Neck Disability Index (NDI). Secondary outcomes included pain intensity assessed via the Visual Analog Scale (VAS), craniovertebral angle (CVA) via photogrammetry, pressure pain threshold (PPT), cervical joint range of motion, dizziness-related disability (Dizziness Handicap Inventory), and the endurance of neck flexor and extensor muscles.
- Conditions
- Neck Pain, Motor Learning, Home Exercise Program
- Being tested
- Internal focus of attention instructions- First, External focus of attention instructions- First, Home exercises
- Keywords
- attentional focus, mechanical neck pain, craniovertebral angle
- Medical subject headings
- Neck Pain
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Internal focus of attention instructions- FirstOther
Participants first received internal focus instructions, directing their attention to their own body, followed by external focus instructions.
External focus of attention instructions- FirstOther
Participants first received internal focus instructions, directing their attention to their own body, followed by external focus instructions.
Home exercisesOther
Participants' home exercise program includes cervical and scapulothoracic stabilization exercises and self-mobilization exercises with the self-sustained natural apophyseal glide (SNAG) method.
| Study group | Role | What they receive |
|---|---|---|
| IFO-First | Experimental | Participants included in the study will follow a home exercise program for 3 days a week for 4 weeks, in accordance with the instructions given to their groups. The IFO-First group will first receive internal attention focus instructions, then external attention focus. Receives: Other: Internal focus of attention instructions- First; Other: Home exercises |
| EFA-Firts | Experimental | Participants included in the study will follow a home exercise program for 3 days a week for 4 weeks, in accordance with the instructions given to their groups. The EFO-First group will first receive external focus instructions, then internal focus of attention instructions. Receives: Other: External focus of attention instructions- First; Other: Home exercises |
| CG | Active comparator | Participants included in the study will follow a home exercise program without any instructions, 3 days a week for 4 weeks. Receives: Other: Home exercises |
What is being measured
The primary outcome is the main question the study is designed to answer.
Neck Disability Index (NDI)
The Neck Disability Index (NDI) was used to assess disability resulting from neck pain. The NDI consists of 10 items: four addressing subjective symptoms (pain intensity, headache, concentration, and sleeping), and six assessing activities of daily living (personal care, lifting, reading, work activities, driving, and recreation). Each item is scored on a scale from 0 to 5, with total scores ranging from 0 (no disability) to 50 (maximum disability); lower scores indicate less disability. According to the literature, the minimal clinically important difference (MCID) for the NDI has been reported to be 7 points (Abbott, 2014).
Measured: The assessment will be performed at two time points: baseline and 4 weeks after the intervention.
Secondary outcomes (7)
Pain Intensity Based on Visual Analog Pain Scale (VAS)
The Visual Analog Scale (VAS) will be used to assess the intensity of pain experienced by patients with neck pain during movement and at rest. According to the VAS, patients are asked to rate their perceived pain intensity on a scale from 0 to 10, where "0" represents "no pain" and "10" represents "the worst pain imaginable.
Measured: The assessment will be performed at two time points: baseline and 4 weeks after the intervention.
Dizzines Handicap Inventory
The Dizziness Handicap Inventory (DHI) will be used to assess patients' quality of life. This scale consists of 25 items that evaluate the aggravating factors related to dizziness and balance disorders, as well as the emotional and functional consequences of vestibular system diseases. The DHI is a self-reported measure with three subscales: functional, emotional, and physical. Patients rate their perceived dizziness-related disability by responding to each item with "Yes," "Sometimes," or "No." Responses are scored as follows: No = 0, Sometimes = 2, and Yes = 4. The total score ranges from 0 to 100, with higher scores indicating greater perceived disability. Patients who score above 10 are recommended to be referred to balance specialists for further evaluation.
Measured: The assessment will be performed at two time points: baseline and 4 weeks after the intervention.
Craniovertebral angle measurement
The craniovertebral angle is defined as the angle formed at the intersection of a line drawn from the tragus of the ear to the C7 vertebra and a horizontal reference line. This angle is commonly used to assess forward head posture. As the angle increases, the degree of forward inclination of the head over the neck also increases. In this study, craniovertebral angle measurements of the participants will be evaluated using a photogrammetric method. For this measurement, markers will be placed on the C7 vertebra and the tragus of the ear, and images of the participants will be captured from both the frontal and sagittal planes.
Measured: The assessment will be performed at two time points: baseline and 4 weeks after the intervention.
Pressure Pain Threshold Measurement (PPT)
The tip of the algometer will be placed perpendicular to the skin, between the acromion and C7, at the midpoint of the upper trapezius muscle, and pressure will be applied at a rate of 1 kg/cm2/s. After an explanation of the measurement and a demonstration of the thenar region of the hand, 3 consecutive PPT measurements will be made at each position, with a 30-second rest between measurements. The average of the PPT measurements will be recorded and the PPT will be evaluated bilaterally.
Measured: The assessment will be performed at two time points: baseline and 4 weeks after the intervention.
Cervical Joint Range of Motion Measurement
Cervical joint range of motion will be measured using a digital goniometer. The assessment will be conducted with the participant seated comfortably on a chair, with both feet flat on the ground, hips and knees positioned at a 90° angle, and only the heels touching the back of the chair. After setting the goniometer to a neutral position, the participant will be instructed to move their head in a standardized manner as far as possible in each direction: flexion, extension, right lateral flexion, left lateral flexion, right rotation, and left rotation. The measurement results will be recorded.
Measured: The assessment will be performed at two time points: baseline and 4 weeks after the intervention.
Endurance Test for Neck Flexors
For endurance testing of the neck flexors, the patient will be asked to chin-in isometrically and then lift the occiput off the surface of the bed while lying supine, both knees flexed, and feet together. The patient will then be instructed to hold the head in this elevated position for as long as possible without assistance. A stopwatch will be used to record the duration of this isometric neck flexion. This phase will be repeated twice with a five-minute interval between each repetition, and the average of the two measurements will be used for data analysis.
Measured: The assessment will be performed at two time points: baseline and 4 weeks after the intervention.
Endurance Test for Neck Extensors
In the prone position, the patient will be instructed to extend their neck over the edge of the couch while securing their upper torso and cervico-thoracic region to the couch. The patient will then chin-in from this neutral position. A stopwatch will be used to record their times in seconds. This phase will be repeated twice with a five-minute interval between each repetition, and the average of the two measurements will be used for data analysis.
Measured: The assessment will be performed at two time points: baseline and 4 weeks after the intervention.
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted3 Aug 2025
- Study start1 May 2025
- Primary completion30 Nov 2025 (estimated)
- Study completion31 Dec 2025 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for Neck PainStudies 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
- This study has a randomized, controlled, single-blind, prospective study design.
- Masking
- Single blind
- Who is masked
- Outcomes assessor
- Enrolment
- 39 participants (estimated)
Sponsor and investigators
- Lead sponsor
- Büşra Tamgüç
- Sponsor type
- University, hospital or other
- Collaborators
- Istanbul Nisantasi University
- Responsible party
- Sponsor-investigator, Büşra Tamgüç, Bahçeşehir University
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT07102199
- Sponsor's protocol ID
- SBETKK2025-4
- Status last verified
- Jul 2025
- First submitted
- 21 Jul 2025
- Last updated
- 3 Aug 2025
- Results posted
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
Study at a glance
From the registry record, last updated by the sponsor on 3 Aug 2025. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Effectiveness of Differently Sequenced Attentional Focus Instructions in a Home Exercise Program for Non-Specific Neck Pain: A Randomized Controlled Single-Blind Trial
- ClinicalTrials.gov ID
- NCT07102199
- Acronym / sponsor ID
- SBETKK2025-4
- Conditions
- Neck Pain, Motor Learning, Home Exercise Program
- Keywords
- attentional focus, mechanical neck pain, craniovertebral angle
- Study type
- Interventional
- Recruitment status
- Active, not recruiting
- Enrolment
- 39 participants (estimated)
- Lead sponsor
- Büşra TamgüçUniversity, hospital or other
- Collaborators
- Istanbul Nisantasi University
- Study start
- 1 May 2025 (actual)
- Primary completion
- 30 Nov 2025 (estimated)
- Study completion
- 31 Dec 2025 (estimated)
- First posted
- 3 Aug 2025 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
According to the International Association for the Study of Pain's 2017 terminology, neck pain is described as an unpleasant sensory and emotional experience originating in the cervical region and potentially radiating toward the scapular area, typically linked to actual or potential tissue injury. Although research on how attentional focus instructions influence postural control remains limited, existing findings suggest that the sequence in which these instructions are delivered can impact sensory processing during postural control assessments. These observations raise compelling questions about the potential benefits of using attentional focus strategies in a structured, sequential manner during neck pain treatment. To date, however, no study has investigated how varying the order of attentional focus cues within a home exercise program affects individuals with non-specific neck pain. This study aimed to fill that gap by evaluating the clinical effectiveness of a home-based exercise protocol utilizing attentional focus instructions in different sequences. The primary outcome was disability level, measured by the Neck Disability Index (NDI). Secondary outcomes included pain intensity assessed via the Visual Analog Scale (VAS), craniovertebral angle (CVA) via photogrammetry, pressure pain threshold (PPT), cervical joint range of motion, dizziness-related disability (Dizziness Handicap Inventory), and the endurance of neck flexor and extensor muscles.
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Single blind (outcomes assessor)
- Number of arms
- 3
- Model description
- This study has a randomized, controlled, single-blind, prospective study design.
| Arm | Type | Receives |
|---|---|---|
| IFO-First | Experimental | Other: Internal focus of attention instructions- First, Other: Home exercisesParticipants included in the study will follow a home exercise program for 3 days a week for 4 weeks, in accordance with the instructions given to their groups. The IFO-First group will first receive internal attention focus instructions, then external attention focus. |
| EFA-Firts | Experimental | Other: External focus of attention instructions- First, Other: Home exercisesParticipants included in the study will follow a home exercise program for 3 days a week for 4 weeks, in accordance with the instructions given to their groups. The EFO-First group will first receive external focus instructions, then internal focus of attention instructions. |
| CG | Active comparator | Other: Home exercisesParticipants included in the study will follow a home exercise program without any instructions, 3 days a week for 4 weeks. |
Who may qualify
- Ages
- 18 to 40 years
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult
Key inclusion criteria (8 listed)
- Aged between 18 and 40 years
- A craniovertebral angle of 53 degrees or less
- A Visual Analog Scale score greater than 3 for pain in the neck and shoulder areas
- Experiencing head and neck pain for a duration exceeding three months
- A Neck Disability Index score ranging from 5 to 24
Key exclusion criteria (13 listed)
- A positive result on the Spurling test
- Reduced or absent reflex responses in the upper extremities,
- Referred pain scoring greater than 7 on the Visual Analog Scale in the affected dermatome
- Diagnosis of cervical spinal stenosis
- Diagnosis of an autoimmune disorder
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Internal focus of attention instructions- FirstParticipants first received internal focus instructions, directing their attention to their own body, followed by external focus instructions. | Other | IFO-First |
| External focus of attention instructions- FirstParticipants first received internal focus instructions, directing their attention to their own body, followed by external focus instructions. | Other | EFA-Firts |
| Home exercisesParticipants' home exercise program includes cervical and scapulothoracic stabilization exercises and self-mobilization exercises with the self-sustained natural apophyseal glide (SNAG) method. | Other | CG, EFA-Firts, IFO-First |
Primary outcome
Neck Disability Index (NDI)
Time frame: The assessment will be performed at two time points: baseline and 4 weeks after the intervention.
The Neck Disability Index (NDI) was used to assess disability resulting from neck pain. The NDI consists of 10 items: four addressing subjective symptoms (pain intensity, headache, concentration, and sleeping), and six assessing activities of daily living (personal care, lifting, reading, work activities, driving, and recreation). Each item is scored on a scale from 0 to 5, with total scores ranging from 0 (no disability) to 50 (maximum disability); lower scores indicate less disability. According to the literature, the minimal clinically important difference (MCID) for the NDI has been reported to be 7 points (Abbott, 2014).
7 secondary outcomes
Pain Intensity Based on Visual Analog Pain Scale (VAS)
Time frame: The assessment will be performed at two time points: baseline and 4 weeks after the intervention.
Dizzines Handicap Inventory
Time frame: The assessment will be performed at two time points: baseline and 4 weeks after the intervention.
Craniovertebral angle measurement
Time frame: The assessment will be performed at two time points: baseline and 4 weeks after the intervention.
Pressure Pain Threshold Measurement (PPT)
Time frame: The assessment will be performed at two time points: baseline and 4 weeks after the intervention.
Cervical Joint Range of Motion Measurement
Time frame: The assessment will be performed at two time points: baseline and 4 weeks after the intervention.
Endurance Test for Neck Flexors
Time frame: The assessment will be performed at two time points: baseline and 4 weeks after the intervention.
Endurance Test for Neck Extensors
Time frame: The assessment will be performed at two time points: baseline and 4 weeks after the intervention.
Results and safety
This study is still under way. Results are not available in the source record yet.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 3 Aug 2025.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
The record lists no contact. Use the official record to reach the sponsor.
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Internal focus of attention instructions- First, External focus of attention instructions- First and Home exercises in people with Neck Pain and Motor Learning, run by Büşra Tamgüç at 1 site in Turkey (Türkiye).
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 8 inclusion and 13 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: under way, not looking for participants, as of the sponsor's last update on 3 Aug 2025. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Turkey (Türkiye). Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
This study is still under way. Results are not available in the source record yet.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Neck Disability Index (NDI) (time frame: The assessment will be performed at two time points: baseline and 4 weeks after the intervention.). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 3 Aug 2025.