Feasibility of a Smartphone-Based Exercise Program for Office Workers With Neck Pain: An Individualized Approach Using a Self-Classification Algorithm

Published:September 27, 2016DOI:



      To explore the feasibility of a newly developed smartphone-based exercise program with an embedded self-classification algorithm for office workers with neck pain, by examining its effect on the pain intensity, functional disability, quality of life, fear avoidance, and cervical range of motion (ROM).


      Single-group, repeated-measures design.


      The laboratory and participants' home and work environments.


      Offices workers with neck pain (N=23; mean age ± SD, 28.13±2.97y; 13 men).


      Participants were classified as having 1 of 4 types of neck pain through a self-classification algorithm implemented as a smartphone application, and conducted corresponding exercise programs for 10 to 12min/d, 3d/wk, for 8 weeks.

      Main Outcome Measures

      The visual analog scale (VAS), Neck Disability Index (NDI), Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36), Fear-Avoidance Beliefs Questionnaire (FABQ), and cervical ROM were measured at baseline and postintervention.


      The VAS (P<.001) and NDI score (P<.001) indicated significant improvements in pain intensity and functional disability. Quality of life showed significant improvements in the physical functioning (P=.007), bodily pain (P=.018), general health (P=.022), vitality (P=.046), and physical component scores (P=.002) of the SF-36. The FABQ, cervical ROM, and mental component score of the SF-36 showed no significant improvements.


      The smartphone-based exercise program with an embedded self-classification algorithm improves the pain intensity and perceived physical health of office workers with neck pain, although not enough to affect their mental and emotional states.


      List of abbreviations:

      app (application), FABQ (Fear-Avoidance Beliefs Questionnaire), NDI (Neck Disability Index), ROM (range of motion), SF-36 (Medical Outcomes Study 36-Item Short-Form Health Survey), VAS (visual analog scale)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Archives of Physical Medicine and Rehabilitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Hoy D.G.
        • Protani M.
        • De R.
        • et al.
        The epidemiology of neck pain.
        Best Pract Res Clin Rheumatol. 2010; 24: 783-792
        • Goode A.P.
        • Freburger J.
        • Carey T.
        Prevalence, practice patterns, and evidence for chronic neck pain.
        Arthritis Care Res. 2010; 62: 1594-1601
        • Skillgate E.
        • Magnusson C.
        • Lundberg M.
        • et al.
        The age- and sex-specific occurrence of bothersome neck pain in the general population—results from the Stockholm public health cohort.
        BMC Musculoskelet Disord. 2012; 13: 185-193
        • Kleinman N.
        • Patel A.A.
        • Benson C.
        • et al.
        Economic burden of back and neck pain: effect of a neuropathic component.
        Popul Health Manag. 2014; 17: 224-232
        • Martin B.I.
        • Deyo R.A.
        • Mirza S.K.
        • et al.
        Expenditures and health status among adults with back and neck problems.
        JAMA. 2008; 299: 656-664
        • Sihawong R.
        • Janwantanakul P.
        • Sitthipornvorakul E.
        • et al.
        Exercise therapy for office workers with nonspecific neck pain: a systematic review.
        J Manipulative Physiol Ther. 2011; 34: 62-71
        • Chiu T.T.
        • Lam T.H.
        • Hedley A.J.
        A randomized controlled trial on the efficacy of exercise for patients with chronic neck pain.
        Spine (Phila Pa 1976). 2005; 30: E1-E7
        • Ylinen J.
        • Takala E.P.
        • Nykanen M.
        • et al.
        Active neck muscle training in the treatment of chronic neck pain in women: a randomized controlled trial.
        JAMA. 2003; 289: 2509-2516
        • Bronfort G.
        • Evans R.
        • Nelson B.
        • et al.
        A randomized clinical trial of exercise and spinal manipulation for patients with chronic neck pain.
        Spine (Phila Pa 1976). 2001; 26: 788-797
        • Tunwattanapong P.
        • Kongkasuwan R.
        • Kuptniratsaikul V.
        The effectiveness of a neck and shoulder stretching exercise program among office workers with neck pain: a randomized controlled trial.
        Clin Rehabil. 2016; 30: 64-72
        • Häkkinen A.
        • Kautiainen H.
        • Hannonen P.
        • et al.
        Strength training and stretching versus stretching only in the treatment of patients with chronic neck pain: a randomized one-year follow-up study.
        Clin Rehabil. 2008; 22: 592-600
        • Ylinen J.
        • Kautiainen H.
        • Wirén K.
        • et al.
        Stretching exercises vs manual therapy in treatment of chronic neck pain: a randomized, controlled cross-over trial.
        J Rehabil Med. 2007; 39: 126-132
        • Röijezon U.
        • Björklund M.
        • Bergenheim M.
        • et al.
        A novel method for neck coordination exercise—a pilot study on persons with chronic non-specific neck pain.
        J Neuroeng Rehabil. 2008; 23: 36
        • Rudolfsson T.
        • Djupsjöbacka M.
        • Häger C.
        • et al.
        Effects of neck coordination exercise on sensorimotor function in chronic neck pain: a randomized controlled trial.
        J Rehabil Med. 2014; 46: 908-914
        • Cleland J.A.
        • Childs J.D.
        • Fritz J.M.
        • et al.
        Development of a clinical prediction rule for guiding treatment of a subgroup of patients with neck pain: use of thoracic spine manipulation, exercise, and patient education.
        Phys Ther. 2007; 87: 9-23
        • Hoving J.L.
        • Koes B.W.
        • de Vet H.C.
        • et al.
        Manual therapy, physical therapy, or continued care by a general practitioner for patients with neck pain. A randomized, controlled trial.
        Ann Intern Med. 2002; 136: 713-722
        • Cleland J.A.
        • Childs J.D.
        • McRae M.
        • et al.
        Immediate effects of thoracic manipulation in patients with neck pain: a randomized clinical trial.
        Man Ther. 2005; 10: 127-135
        • Korthals-de Bos I.B.
        • Müllner M.
        • Hoving J.L.
        • et al.
        Cost effectiveness of physiotherapy, manual therapy, and general practitioner care for neck pain: economic evaluation alongside a randomised controlled trial.
        BMJ. 2003; 326: 911-914
        • Wang W.T.
        • Olson S.L.
        • Campbell A.H.
        • et al.
        Effectiveness of physical therapy for patients with neck pain: an individualized approach using a clinical decision-making algorithm.
        Am J Phys Med Rehabil. 2003; 82: 203-218
        • Childs J.D.
        • Fritz J.M.
        • Piva S.R.
        • et al.
        Proposal of a classification system for patients with neck pain.
        J Orthop Sports Phys Ther. 2004; 34: 686-696
        • Fritz J.M.
        • Brennan G.P.
        Preliminary examination of a proposed treatment-based classification system for patients receiving physical therapy interventions for neck pain.
        Phys Ther. 2007; 87: 513-524
        • Björklund M.
        • Djupsjöbacka M.
        • Svedmark Å.
        • et al.
        Effects of tailored neck-shoulder pain treatment based on a decision model guided by clinical assessments and standardized functional tests. A study protocol of a randomized controlled trial.
        BMC Musculoskelet Disord. 2012; 13: 75
      1. Korea Internet and Security Agency. The survey of mobile internet use. Seoul: Ministry of Science, ICT and Future Planning; 2015.

        • Blodt S.
        • Pach D.
        • Roll S.
        • et al.
        Effectiveness of app-based relaxation for patients with chronic low back pain (Relaxback) and chronic neck pain (Relaxneck): study protocol for two randomized pragmatic trials.
        Trials. 2014; 15: 490
        • Amorim A.B.
        • Pappas E.
        • Simic M.
        • et al.
        Integrating Mobile health and Physical Activity to reduce the burden of Chronic low back pain Trial (IMPACT): a pilot trial protocol.
        BMC Musculoskelet Disord. 2016; 17: 36
        • Edmond S.L.
        • Cutrone G.
        • Werneke M.
        • et al.
        Association between centralization and directional preference and functional and pain outcomes in patients with neck pain.
        J Orthop Sports Phys Ther. 2014; 44: 68-75
        • Kjellman G.
        • Öberg B.
        A randomized clinical trial comparing general exercise, McKenzie treatment and a control group in patients with neck pain.
        J Rehabil Med. 2002; 34: 183-190
        • Healey K.C.
        • Hatfield D.L.
        • Blanpied P.
        • et al.
        The effects of myofascial release with foam rolling on performance.
        J Strength Cond Res. 2014; 28: 61-68
        • Falla D.L.
        • Jull G.A.
        • Hodges P.W.
        Patients with neck pain demonstrate reduced electromyographic activity of the deep cervical flexor muscles during performance of the craniocervical flexion test.
        Spine (Phila Pa 1976). 2004; 29: 2108-2114
        • Jull G.
        • Trott P.
        • Potter H.
        • et al.
        A randomized controlled trial of exercise and manipulative therapy for cervicogenic headache.
        Spine (Phila Pa 1976). 2002; 27: 1835-1843
        • Biondi D.M.
        Physical treatments for headache: a structured review.
        Headache. 2005; 45: 738-746
        • Wainner R.S.
        • Fritz J.M.
        • Irrgang J.J.
        • et al.
        Reliability and diagnostic accuracy of the clinical examination and patient self-report measures for cervical radiculopathy.
        Spine (Phila Pa 1976). 2003; 28: 52-62
        • Dionne C.P.
        • Bybee R.F.
        • Tomaka J.
        Inter-rater reliability of McKenzie assessment in patients with neck pain.
        Physiotherapy. 2006; 92: 75-82
        • McKenzie R.
        • May S.
        The lumbar spine mechanical diagnosis and therapy.
        2nd ed. Spinal Publications New Zealand Ltd, Waikanae2003
        • May S.
        • Aina A.
        Centralization and directional preference: a systematic review.
        Man Ther. 2012; 17: 497-506
        • Pool J.J.
        • Ostelo R.W.
        • Hoving J.L.
        • et al.
        Minimal clinically important change of the neck disability index and the numerical rating scale for patients with neck pain.
        Spine (Phila Pa 1976). 2007; 32: 3047-3051
        • Vernon H.
        • Mior S.
        The Neck Disability Index: a study of reliability and validity.
        J Manipulative Physiol Ther. 1991; 14: 409-415
        • McHorney C.A.
        • Ware Jr., J.E.
        • Raczek A.E.
        The MOS 36-Item Short-Form Health Survey (SF-36): II. Psychometric and clinical tests of validity in measuring physical and mental health constructs.
        Med Care. 1993; 31: 247-263
        • Waddell G.
        • Newton M.
        • Henderson I.
        • et al.
        A Fear-Avoidance Beliefs Questionnaire (FABQ) and the role of fear-avoidance beliefs in chronic low back pain and disability.
        Pain. 1993; 52: 157-168
        • Jacob T.
        • Baras M.
        • Zeev A.
        • et al.
        Low back pain: reliability of a set of pain measurement tools.
        Arch Phys Med Rehabil. 2001; 82: 735-742
        • Vikne H.
        • Bakke E.S.
        • Liestøl K.
        • et al.
        The smoothness of unconstrained head movements is velocity-dependent.
        Hum Mov Sci. 2013; 32: 540-554
        • Vikne H.
        • Bakke E.S.
        • Liestøl K.
        • et al.
        Muscle activity and head kinematics in unconstrained movements in subjects with chronic neck pain; cervical motor dysfunction or low exertion motor output.
        BMC Musculoskelet Disord. 2013; 14: 314
        • Bertozzi L.
        • Gardenghi I.
        • Turoni F.
        • et al.
        Effect of therapeutic exercise on pain and disability in the management of chronic nonspecific neck pain: systematic review and meta-analysis of randomized trials.
        Phys Ther. 2013; 93: 1026-1036
        • Salo P.
        • Ylonen-Kayra N.
        • Hakkinen A.
        • et al.
        Effects of long-term home-based exercise on health-related quality of life in patients with chronic neck pain: a randomized study with a 1-year follow-up.
        Disabil Rehabil. 2012; 34: 1971-1977
        • Cramer H.
        • Lauche R.
        • Hohmann C.
        • et al.
        Randomized-controlled trial comparing yoga and home-based exercise for chronic neck pain.
        Clin J Pain. 2013; 29: 216-223