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.
University students aged 18-30 years enrolled in a degree program at Riphah International University.
Daily sitting duration ≥ 5 hours (academic and/or device-related activities).
Presence of at least one observable postural deviation confirmed at baseline assessment: forward head posture (CVA < 50°), rounded shoulders (protracted shoulder distance in supine line), or thoracic kyphosis (> 40° via digital inclinometer).
Smartphone ownership and basic digital literacy
History of spinal surgery, vertebral fracture, or major cervical/thoracic trauma within the past 12 months.
Diagnosed neurological disorders affecting posture or motor control (e.g., Parkinson's disease, stroke, cervical dystonia).
Structural spinal deformities requiring active medical or surgical management (e.g., scoliosis Cobb angle > 20°, Scheuermann's kyphosis).
Current participation in physiotherapy, chiropractic treatment, or another structured posture correction program.
Parallel
Wearable postural biofeedback device
DeviceA 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.
App based Postural Reminder
BehavioralA 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
Conventional Cervicothoracic Exercise Therapy
Other interventionA 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.
Thoracic Kyphosis Angle
Degree of thoracic spinal curvature (T1 - T12) measured using a digital inclinometer. Normal range 20 degree to 45 degree
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
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
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.
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
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.
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