Application Based Behavior Nudging Active Breaks Versus Conventional Ergonomic Education for Thoracic Mobility and Neck Pain in Office Workers

This study aims to compare app based behavior nudging active breaks with conventional ergonomic education and exercise for office workers experiencing non specific neck and upper back pain. Prolonged sitting, computer use, static postures, and repetitive neck movements can contribute to neck discomfort and reduced upper back mobility. The study focuses on whether regular short movement breaks can help improve these problems.

A total of 64 office workers will participate in the study and will be randomly divided into two groups, with 32 participants in each group. The study will be conducted in corporate offices in Islamabad. Participants will be assessed for neck pain, neck related disability, work limitations, deep neck muscle endurance, and thoracic spine mobility.

Both groups will receive a 15 minute ergonomic education session covering appropriate sitting posture, monitor height, keyboard and mouse placement, and back support. Both groups will also be taught four mobility exercises: seated thoracic extension mobilization, scapular wall slides, and seated thoracic rotation mobilization.

The app based group will receive reminders approximately 7-8 times during each workday for six weeks. Each reminder will prompt participants to take a one minute active break and perform the prescribed mobility exercises. The app will also provide visual reminders and progress features to encourage regular participation. Weekly monitoring and therapist feedback will be provided to support correct exercise performance and adherence.

The conventional group will perform the same mobility exercises twice daily, in the morning and afternoon, without app reminders. They will receive written or electronic instructions about posture, movement safety, and monitoring discomfort, along with weekly self reports of exercise completion and discomfort.

After six weeks, there will be a one week period without supervised sessions or reminders. In week eight, participants will undergo a final assessment. The researchers will compare changes in neck pain, neck disability, thoracic mobility, deep neck muscle endurance, work limitations, and adherence between the two groups. Participant feedback about the intervention will also be collected.

The study is designed as a single-blinded, two-arm randomized controlled trial. Data will be analyzed using appropriate statistical tests depending on the distribution of the data, with analysis performed using SPSS version 29.

The study is intended to determine whether app based reminders combined with short active breaks can provide a practical approach for improving neck pain, neck related disability, thoracic mobility, work productivity, and adherence among office workers.

Inclusion criteria

• 25-50 years, employed in call-center or IT support roles for ≥30 hours per week.

• Sub-acute or chronic non-specific neck and upper thoracic pain
• Neck Disability Index (NDI) score ≥10/50 indicating mild to moderate disability.
• Access to a smartphone compatible with the intervention app
• Able to understand and follow app prompts in English/Urdu.

Exclusion criteria

• Specific neck pathology (cervical radiculopathy, myelopathy, fracture, malignancy, infection, or inflammatory disorders such as rheumatoid arthritis).
• Post-surgical conditions of the cervical or thoracic spine or shoulder within the past 6 months.
• Severe thoracic kyphosis, scoliosis, or other structural spinal deformities interfering with movement assessment.
• Pregnancy or conditions contraindicating light mobility exercises (e.g., vertigo, uncontrolled hypertension).
• Ongoing structured physiotherapy or chiropractic management for neck or upper back pain.
• Planned leave exceeding 2 consecutive weeks during the trial period.