Thesis (M.Sc.) -Cairo University, 2023.

Bibliography: pages 93-110.

Objective: This systematic review was designed to evaluate the effect of cervico-
thoracic mobilization and therapeutic exercises on craniovertebral angle in degrees
or forward head posture measurement in centimeters, and thoracic kyphosis in
subjects with forward head posture after analyzing these results from all possible
randomized control trials. Methods: Six electronic databases including PubMed,
Cochrane library, Scopus, Web of Science, ScienceDirect, and PEDro were
searched since January 2010 up to January 2023. Additionally, manual search of
references and citations of relevant studies was performed in Scopus database.
Randomized control trials were included if the intervention used was cervico-
thoracic mobilization (cervical and thoracic mobilization together and/or
cervicothoracic junction mobilization) and any form of therapeutic exercise in
managing forward head posture, and when outcomes measured included: All/some
of the following: craniovertebral angle, forward head posture measurement in
centimeters, and thoracic kyphosis (using Occiput Wall Distance, and/or
flexicurve). Two independent reviewers performed screening of articles, data
extraction, and quality assessment using Cochrane risk-of-bias tool version 2 for
randomized trials. The Grading of Recommendation Assessment, Development,
and Evaluation framework was used to detect certainty of evidence. Any conflicts
were resolved by a third reviewer. Two main outcomes were analyzed; forward
head posture measurement and thoracic kyphosis. Results: Out of 1,335 screened
studies, only 4 studies with 131 participants met the inclusion criteria. 2 meta-
analyses were done for data analysis, and results showed that there was no
significant difference in the overall effect of forward head posture measurement;
P= 0.89, and thoracic kyphosis; P= 0.81 between intervention and control groups.






The certainty of evidence was low for both outcomes. Results failed to reject null
hypotheses (H01 and H02). Conclusion: Cervico-thoracic mobilization is not
superior to therapeutic exercises in improving craniovertebral angle or forward
head posture measurement in centimeters, and thoracic kyphosis in subjects with
forward head posture. This evidence was based on a limited number of randomized
control trials and more high-quality randomized control trials are needed to provide
a wider representation of data, and more reliable evidence.

تم البحث في ستة قواعد بيانات إلكترونية و هي كالاتي: PubMed وLibrary Cochrane و Scopus و Web of Science و ScienceDirect و PEDro من شهر يناير ٢٠١٠ حتى شهر يناير عام ٢٠٢٣. بالإضافة إلى ذلك ، تم إجراء البحث اليدوي في مراجع الدراسات ذات الصلة في قاعدة البينات Scopus. و تم تقييم جودة الدراسات المؤهلة باستخدام أداة كوكرين لخطر التحيز الإصدار الثاني.(RoB 2) تم استخدام الإطار المعياري لتقييم وتصنيف الأدلة و إعطاء التوصيات ((The GRADE framework لتحديد جودة الأدلة. أظهرت نتائج هذه المراجعة المنهجية أنه لا يوجد فرق كبير بين مجموعة التدخل والمجموعة الضابطة لقياس وضعية الرأس الامامية و انحناء العمود الفقري الصدري ، و أن تأثيرالتمارين الحركية للفقرات العنقية و فقرات الصدر للذين يعانون من وضعية الرأس الامامية لا يتفوق على التمارين العلاجية. و تم رفض فرضية العدم. و يعتمد هذا الدليل على عدد محدود من الدراسات و لا تزال هناك حاجة لدراسات أخرى عالية الجودة

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