Effect of Attentional Focus Order in Home Exercise for Neck Pain

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).

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.

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.

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.

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.

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.

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.

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.