Effectiveness of Telerehabilitation in Individuals with Upper Crossed Syndrome Across Diverse Age Demographics: Study Protocol for a Randomized Controlled Trial.

BACKGROUND

Upper crossed syndrome (UCS), characterized by muscular imbalances and postural misalignments such as forward head posture and rounded shoulders, is increasingly prevalent among sedentary populations. Traditional rehabilitation often lacks adherence and supervision, whereas telerehabilitation enhances both through real-time remote supervision. However, limited evidence exists comparing the effectiveness of telerehabilitation and home exercise programs for managing UCS across age groups, particularly regarding age-specific adherence and clinical outcomes. This study aims to compare the effectiveness of telerehabilitation-supervised programs versus home exercise programs in improving posture, muscle strength, and adherence in individuals with UCS across age groups.

METHODOLOGY: A randomized controlled trial will be conducted with 56 asymptomatic UCS participants stratified by age. Participants will be randomly assigned to either a telerehabilitation group or a home exercise program (HEP) group. Both groups will follow an identical 6-week corrective exercise protocol (3 sessions/week). The telerehabilitation group will receive live video supervision via the Zoom platform, while the control group will follow printed paper handouts. Primary outcomes, including craniovertebral angle and forward shoulder angle, will be assessed using photogrammetry. Secondary outcomes include scapular muscle strength, deep cervical flexor endurance, and exercise adherence.

DISCUSSION: The expected findings will highlight the comparative effectiveness of telerehabilitation and HEP, and guide age-appropriate physiotherapeutic interventions and integration of digital platforms into routine musculoskeletal care.

TRIAL REGISTRATION: This trial was approved by the Institutional Ethics Committee of Jamia Millia Islamia (JMI), New Delhi, India (20/11/568/JMI/IEC/2025) and registered with CTRI as CTRI/2026/01/101387. © 2026 Wiley Periodicals LLC.