Conventional Physiotherapy Program

1. Treatment Frequency and Duration

   Frequency: 3 sessions per week

   Duration: 8 weeks

   Session length: 45-60 minutes

2. Hot Pack Application (10-15 minutes)

Purpose: Reduce pain, improve soft-tissue extensibility, and prepare muscles for exercise.

Procedure:

Moist hot pack applied to the cervical region.

Temperature: 40-45°C (comfortable warmth, checked to avoid burns).

Duration: 10-15 minutes with adequate towel layers.

Neck Endurance and Strength Training (30-40 minutes)

Exercise

and

1. Delivery Method

   Initial Education Session:

   A 45-minute one-on-one session with a physiotherapist or trained researcher.

   Delivered face-to-face using visual aids (slides, posters, printed guide).

   Explains what sleep hygiene is, why it matters in chronic neck pain, and how to apply each strategy.

   Follow-up Sessions:

   Weekly 15-20-minute reinforcement sessions (in-person or by phone/video call).

   Used to review progress, clarify doubts, troubleshoot barriers, and adjust advice if necessary.

   Written Materials:

   A patient booklet summarizing all recommendations in simple language, including diagrams of neck-friendly sleeping postures.

   A daily sleep diary to track bedtime, wake time, naps, and perceived sleep quality.

2. Program Content A. Regular Sleep-Wake Timing

Go to bed at the same time every night and wake at the same time every morning, even on weekends.

Use alarms only for waking, not for forcing sleep onset.

Limit naps to <30 minutes, no later than 4

advices and home program

Sleep Hygiene Techniques

The sleep hygiene program includes education and behavioral strategies to promote healthier sleep patterns, delivered alongside physiotherapy exercises. Key components are:

Regular Sleep-Wake Schedule

Encourage patients to maintain consistent bedtime and wake-up times, even on weekends.

Avoid excessive time in bed when not sleeping.

Optimizing the Sleep Environment

Ensure a quiet, dark, and cool bedroom (18-22°C).

Use supportive pillows to maintain neutral cervical alignment and reduce neck strain.

Remove distractions such as TVs, mobile phones, and bright lights.

Pre-Sleep Routine

Establish a relaxing wind-down routine (e.g., gentle stretching, breathing exercises, reading).

Avoid mentally stimulating activities or heavy problem-solving before bedtime.

Limiting Stimulants and Alcohol

Avoid caffeine, nicotine, and alcohol at least 4-6 hours before bedtime.

Avoid heavy meals close to bedtime; a light snack is acceptable if hungry.

Daytime Habits t

Pittsburgh Sleep Quality Index (PSQI):

The PSQI is a widely used and validated self-reported questionnaire designed to assess sleep quality and disturbances over a 1-month period. It consists of 19 individual items that generate seven component scores: subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleep medication, and daytime dysfunction. Each component is scored on a 0-3 scale, and the sum of these components yields a global score ranging from 0 to 21, with higher scores indicating poorer sleep quality. A global score greater than 5 is typically used to distinguish poor sleepers from good sleepers. The PSQI provides a comprehensive overview of both qualitative and quantitative aspects of sleep, making it a suitable primary outcome measure in this study.

Neck Disability Index (NDI):

The NDI is a standardized, condition-specific outcome measure used to determine the level of disability in individuals with neck pain. It contains 10 items addressing pain intensity and the impact of neck pain on daily activities such as personal care, lifting, reading, concentration, work, driving, sleeping, and recreation. Each item is scored on a 0-5 scale, with the total score ranging from 0 to 50, which can then be expressed as a percentage. Higher scores reflect greater disability. The NDI is recognized as a reliable and valid tool for evaluating functional limitations and tracking treatment progress in patients with chronic neck pain.

Visual Analog Scale (VAS) for Pain:

The VAS is a simple, validated tool used to measure pain intensity. It typically consists of a 10-centimeter horizontal line, with the left end representing "no pain" and the right end representing "worst imaginable pain." Patients are asked to mark a point along the line that best represents their perceived pain intensity at the time of assessment. The score is determined by measuring the distance in centimeters from the left end of the line to the patient's mark, yielding a score between 0 and 10. The VAS is highly sensitive to changes in pain over time and is widely used in clinical and research settings to evaluate treatment effectiveness.