JMIR Publications

ABSTRACT

Background:

Text Neck Syndrome (TNS) is a contemporary musculoskeletal condition characterized by forward head posture (FHP) and neck pain resulting from prolonged cervical flexion, primarily induced by the extensive use of mobile devices.

Objective:

To evaluate the feasibility and acceptability of a downloadable mobile phone application ("HUNCHED – your text neck solution") and to determine whether selected clinical and functional outcome measures—specifically the correction of FHP and the reduction of neck strain and dysfunction—were responsive to change over a 14-day intervention period.

Methods:

Thirty-two university-aged students participated in this 14-day, single-arm intervention trial, which included two laboratory visits (Days 1 and 14). The HUNCHED application provided on-screen postural alerts when the mobile device angle indicated a position associated with increased cervical flexion. Feasibility was evaluated based on participant recruitment, retention, protocol adherence, and study assessment completion. Acceptability was measured using a self-report questionnaire. Clinical and functional outcomes included FHP assessed via the Tragus-to-Wall (TTW) test, neck pain and interference measured by the Brief Pain Inventory (BPI), neck disability evaluated through the Neck Disability Index (NDI), and movement-evoked pain during cervical active range of motion (ROM) with passive overpressure.

Results:

Recruitment and retention rates exceeded predefined benchmarks (≥90%), with a 9% loss to follow-up and 100% data completeness. The HUNCHED application demonstrated acceptable usability. Exploratory outcomes all demonstrated responsiveness to change, favoring improvements in symptoms and function over the 14-day intervention. Effect sizes ranged from small (0.1) to medium (0.4) [BPI: 0.1–0.4, NDI: 0.4, FHP: 0.4].

Conclusions:

This 14-day, single-arm pilot study demonstrated acceptable recruitment and retention while identifying modest pre-to-post-intervention improvements in selected symptomatic and postural outcomes. Because this study lacked a control group, efficacy cannot be definitively established from the sample. These findings provide foundational data to inform a larger randomized controlled trial utilizing objective adherence and posture monitoring.