This randomized controlled trial aims to compare the effects of clinical-based rehabilitation and synchronized telerehabilitation on pain, exercise adherence, and functional disability in patients with Grade-II cervical spondylosis. A total of 52 participants will be randomly allocated into two parallel groups. Both groups will receive a standardized 6-week rehabilitation program, including cervical mobility exercises, strengthening, isometric exercises, stretching, and Mulligan self-mobilization techniques. The clinical group will receive in-person physiotherapy, while the telerehabilitation group will undergo real-time supervised sessions via video conferencing. Outcome measures will include pain (Numeric Pain Rating Scale), functional disability (Neck Disability Index), and exercise adherence (Exercise Adherence Rating Scale), assessed at baseline and post-intervention. The study aims to determine whether synchronized telerehabilitation is as effective as clinical-based rehabilitation and may provide a more accessible alternative for delivering physiotherapy care.

Cervical spondylosis is a common degenerative condition of the cervical spine characterized by disc degeneration, osteophyte formation, and reduced cervical mobility, leading to neck pain and functional limitations. Grade-II cervical spondylosis represents a stage where patients are symptomatic but remain suitable for conservative management. Physiotherapy, particularly exercise-based rehabilitation, is widely used to improve pain, mobility, and functional capacity through strengthening, stretching, and neuromuscular re-education.

Clinical-based rehabilitation provides in-person physiotherapy with direct supervision, manual guidance, and real-time correction of exercises. However, access to such care is often limited due to barriers such as travel distance, cost, and time constraints. Synchronized telerehabilitation, delivered through real-time video conferencing, offers a potential alternative by enabling remote supervision, feedback, and patient engagement while maintaining continuity of care.

This randomized controlled trial aims to compare the effectiveness of clinical-based rehabilitation and synchronized telerehabilitation in patients with Grade-II cervical spondylosis. A total of 52 participants will be randomly assigned to two parallel groups. Both groups will receive a standardized 6-week rehabilitation program consisting of cervical range-of-motion exercises, deep cervical muscle strengthening, isometric exercises, stretching of the upper trapezius and levator scapulae, and Mulligan self-mobilization techniques (SNAGs). The clinical group will attend in-person sessions, while the telerehabilitation group will receive real-time supervised sessions via video conferencing.

Outcome measures include pain intensity assessed by the Numeric Pain Rating Scale (NPRS), functional disability measured by the Neck Disability Index (NDI), and exercise adherence evaluated using the Exercise Adherence Rating Scale (EARS), assessed at baseline and post-intervention.This study aims to determine whether synchronized telerehabilitation is comparable to clinical-based rehabilitation and may provide an accessible, cost-effective alternative for delivering physiotherapy care

Inclusion Criteria:

• Middle age adults (45-64) years
• Both gender ( male and female )
• Clinical daignosis of cervical spondylosis grade 2
• Mild to moderate pain on NPRS
• Sub acute stage ( 2-6 weeks) of grade 2 cervical spondylosis
• Able to follow instructions and give informed consent (cognitively able) Neurologically stable

Exclusion Criteria:

• Prior cervical spine surgery within the last 1 months or cervical instability.
• Inflammtory or systemic rheumatologic disease affecting the cervical spine (e.g., active rheumatoid arthritis ) or infection, tumor, fracture.
• Severe cardiopulmonary or other medical comorbidity that contraindicates exercise (unstable angina, uncontriolled hypertension, recent MI)
• Severe hearing or visual impairment
• No smoking and daibetic history

baseline participants

Blinding of participants and therapists is not possible due to the nature of interventions, as participants will know whether they are receiving clinical-based rehabilitation or synchronized telerehabilitation. However, a single-blind design will be used in which the outcome assessor remains blinded to group allocation. The assessor will not be involved in treatment delivery and will be instructed not to inquire about or be informed of participant group assignment. Outcome measures including NPRS, NDI, and EARS will be collected by the blinded assessor at baseline and post-intervention. Data analysis will also be performed using coded groups to reduce assessment and analytical bias.