This experimental study was carried out at BV (DU), School of Physiotherapy on 63 female homemakers residing at Sangli city, Maharashtra. The duration of study was one year from March 2023 to April 2024. Ethical clearance was obtained from the institution ethical committee with reference no. BV(DU)/SI No.2023-24/09 prior to the commencement of the study. The guidelines of Indian Council of Medical Research [15] were followed throughout the interview and treatment and all the safety precautions were taken. The study was conducted on 63 homemakers having non-specific NP who were consulted and were assessed in the hospital Physiotherapy OPD.

Inclusion criteria:

Exclusion criteria:

The ICF functional profile checklist was developed for evaluation of functional disability among home makers involving the non-specific NP using ICF codes as a guide [16]. The final core set chosen for evaluation of functional disability in home makers is as follows [Table/Fig-1]. The entire study procedure is explained in [Table/Fig-2].

[Table/Fig-2]:

Flow chart of methodology.

Structured exercise programme was set according to the FITT principle [17] [Table/Fig-3]. The FITT principle is a set of guidelines [18] used to create a safe and effective exercise programme. It stands for frequency, intensity, time, and type [Table/Fig-4].

[Table/Fig-3]:

Structured exercise protocol.

1	Progressive neck isometrics
	Press your palm against your forehead. Resist with your neck muscles. Hold for 10 seconds. Relax. Repeat 5 times.
2	Dynamic exercises
a	Dumbbell curls3 sets of 10 curls with 5 sec rest in between each set.
b	Dumbbell press3 sets of 10 repetitions.
c	Dumbbell pullover3 sets of 10 repetitions.
d	Dumbbell shrugsFor dumbbell shrugs, begin by using a weight of 3 lbs for 3 sets of 10 repetitions.
3	Stretching exercises
	Each exercise is done for 30 seconds and repeated three times.
4	Telerehabilitation

Statistical analysis for the present study was done using Statistical Package of Social Sciences (SPSS) version 23 so as to verify the result obtained. For this purpose, data was entered into an excel spread sheet, tabulated and subjected to statistical analysis. Various statistical measures such as mean, frequency, standard deviation were used. Wilcoxon Matched pairs test and dependent t-test were used to compare pretest and post-test VAS, NDI, performance, and MMT scores. The p-value <0.05 (at 5% level of significance).

The study was done on only female homemakers, out of 63 homemakers 50% of them had mild to moderate amount of NP which was found with the help of ICF qualifiers.

Code d230 (carrying out daily routine): 83.84% improvement (n=52)

Code d4103 (sitting): 100.00% improvement (maximum improvement) (n=63)

Code d4104 (standing): 53.12% improvement (n=33)

Code d4105 (bending): 40.86% improvement (minimum improvement) (n=26)

Code d430 (lifting and carrying objects): 50.68% improvement (n=32)

Code d450 (walking): 71.43% improvement (n=45)

[Table/Fig-5] shows Comparison of pretest and post-test VAS scores by Wilcoxon Matched pairs test. A significant difference was observed between pretest and post-test VAS scores (Z=6.7359, p=0.001) at 5% level of significance. It means that, a significant 68.46% reduction was seen in VAS scores after treatment.

[Table/Fig-6] shows Comparison of pretest and post-test NDI scores by dependent t-test. A significant difference was observed between pretest and post-test NDI scores (t=36.0264, p=0.001) at 5% level of significance. It means that, a significant 83.68% reduction was seen in NDI scores after treatment with effect size 0.9570.

[Table/Fig-7] shows the status of b134 (sleep functions), b28010 (pain in head and neck) and nature and extent of different body Structure. In the code b134 majority of the participant scored 0, which means there was no impairment in the sleep function. In code b28010 majority of the participant scored 1, which means there was mild impairment in the structures that caused pain in the neck.

In code s7104 (muscles of head and neck region) majority of the participant had mild impairment in muscles of head and neck region with no change in the structure. In code s7108 (structure of head and neck region, other specified) majority of participant had no impairment with no change in the structure. In code s76000 (cervical vertebral column) majority of the participants had no impairment with no change in the structure.

[Table/Fig-8] shows the Comparison of performance -pretest and performance post test scores (n=63) of different parameters by Wilcoxon Matched pairs test. Significant improvement was seen in carrying out daily routine (p≤0.001), sitting (p=0.0431) standing (p≤0.001), bending (p≤0.001); lifting and carrying objects (p≤0.001) and walking (p=0.0051).

[Table/Fig-9] shows comparison of pretest and post test scores of different parameters of MMT by Wilcoxon Matched pairs test. It showed a significant improvement in all the muscles of the neck namely, flexors, extensors, right flexors, left flexors, right rotators, and left rotators. Maximum improvement was seen in flexors and extensors and minimum improvement was seen in right and left rotators.

This experimental trial involved 63 subjects, all homemakers with a mean age of 36 years, experiencing non-specific NP. On the first day, individuals with a VAS rating between 2-4 received treatment at the clinical setup in the hospital. They were then instructed to perform prescribed exercises at home daily for the next 29 days, under therapist supervision through telerehabilitation. Additionally, they received ergonomic advice to improve their daily working patterns. The data analysis showed a statistically significant difference in the effectiveness of the interventions for NP reduction, therefore we can reject the null hypothesis, which states no difference. The study found evidence for different intervention effects. Non-specific NP is prevalent among homemakers, leading to activity limitation and participation restriction. Despite extensive literature on non-specific NP, there is a scarcity of documentation on the associated limitations in homemakers in developing countries like India.

The present study found a notable prevalence of sleep impairments (25% mild, 23.3% moderate, 13.3% severe) among homemakers with NP. This aligns with research suggesting that NP can be associated with poorer sleep quality [19]. In a study done on homemakers it was seen that homemakers engage in prolonged housework involving repetitive hand movements, bending, kneeling, and squatting, contributing to MSP [11]. The study emphasised the need for occupational health professionals to consider housework and homemakers in their research and policy agendas, particularly exploring the interaction between specific occupations, housework, and MS symptoms. Most studies indicate a higher incidence of NP among women, and the present study aligns with this trend, as homemakers with an average age of 36 years suffered from non-specific pain [13]. Exercises, specifically neck exercises and isometrics, were employed to alleviate NP in this study. Previous research supports the positive effects of regular exercise in reducing pain and enhancing the body’s endogenous inhibitory systems. Regular exercise is pivotal for boosting overall muscle strength and development. In our recent study, a combination of neck exercises and isometrics proved effective in relieving NP. Lima LV et al., research indicates that regular exercise not only alleviates pain but also reduces NMDA receptor phosphorylation, signifying diminished central facilitation. Furthermore, sustained exercise lowers serotonin transporter expression, raises serotonin levels, and increases opioids within central inhibitory pathways like the PAG and RVM [14]. This underscores exercise’s ability to leverage our innate inhibitory systems for pain relief. In a distinct study, it was observed positive outcomes from a 5-week isometric quadriceps exercise programme, manifesting in increased quadriceps muscle strength, diminished pain, and enhanced functional ability in knee osteoarthritis patients [20].

In the present study, neck isometrics demonstrated positive results by increasing strength and reducing pain in homemakers with non-specific NP. Research indicates that, in addition to clinical exercises, Home Exercise Programmes (HEPs) play a crucial role in alleviating NP and maintaining muscle endurance [21]. Zronek M et al., study further supports this, concluding that HEPs incorporating self-mobilisations or exercises targeting specific spinal levels effectively reduce NP, enhance function, and diminishes disability, ultimately improving quality of life. The combination of HEPs with other conservative interventions yields varying degrees of benefit, as indicated by a range of effect sizes [22].

Traditional rehabilitation can be challenging for homemakers due to time constraints, transportation difficulties, financial burden and accessibility issues. Considering the challenges homemakers face in visiting hospitals regularly, a telerehabilitation approach was adopted, proving effective over 29 days. Telerehabilitation was deemed cost-effective, particularly beneficial for individuals in remote areas with limited access to traditional rehabilitation services [23]. Telerehabilitation offers a sustainable solution to these challenges, making it a promising shift in healthcare delivery. The study helped in reducing travel and increasing the energy efficiency lowering carbon footprint. It fostered social sustainability of homemakers by improving quality of life, reduced caregiver burden & enhanced access to specialists. There are studies that support the present study. Study on Efficacy and long-term sustainability of a telerehabilitation programme for patients with knee osteoarthritis found that telerehabilitation was as effective as in-person therapy and led to improved patient satisfaction and adherence [24]. A systematic review of effectiveness and cost-effectiveness examined the effectiveness and cost-effectiveness of telehealth interventions for older adults with various chronic conditions. It found that telehealth can be an effective and cost-effective alternative to in-person care for many conditions [25].

The study utilised the ICF framework to analyse its impact on disability and pain. The findings showed a moderate amount of pain in 50% of homemakers, aligning with the ICF qualifiers. The ICF model is considered valuable in understanding and addressing specific functional problems related to NP. Andelic N et al., found that the specific functional problems identified in their study align well with the ICF model [26]. Numerous connections to activities and participation categories, including mobility, domestic life, employment, and social and civic life, imply that a comprehensive approach involving a multidisciplinary team is crucial for the rehabilitation of NP-related disability. The present study similarly aligns with the ICF model, identifying specific functional problems in homemakers, thereby offering valuable insights for the rehabilitation of neck-related disability.

The NDI was employed as a reliable tool to measure self-reported NP -related disability [27]. The study contributes to the body of knowledge linking NDI items to the ICF codes, emphasising the comprehensive approach required for NP related disability rehabilitation. Overall, the research offers insights into the challenges faced by homemakers with non-specific NP and the effectiveness of telerehabilitation and targeted exercises in improving their condition [28]. Combining structured neck exercises and ergonomic improvements can effectively reduce NP, increase strength, and improve quality of life in homemakers. The ICF corset may be a useful tool for evaluating NP before and after treatment. Telerehabilitation is a promising treatment option for people who have difficulty attending in-person appointments.

The study involved only 63 subjects, which limits the generalisability of the findings to a larger population of homemakers with NP. The intervention lasted only 30 days, which may not be sufficient to determine the long-term effectiveness of the programme. The study only included homemakers with a VAS rating between 2-4 potentially excluding those with more severe or less severe pain. The study did not account for socio-economic factors that may influence pain perception and access to healthcare. The study did not explore the potential role of mental health factors such as stress or anxiety in NP. Pain tolerance and adherence to the exercise programme can vary significantly between individuals.

A telerehabilitation programme combining exercises and ergonomics improved NP in homemakers, suggesting it’s potential and warranting further study. This study not only demonstrated that a combined approach of structured neck exercises and ergonomic interventions effectively reduces pain, increases strength, and life quality in homemakers with NP, but it also contributed to their overall well-being through sustainable practices. By effectively managing NP and preventing future issues, this approach can potentially reduce the need for expensive medical consultations, medications, and even surgeries, promoting long-term financial sustainability for homemakers and their families. Reduced pain and increased strength lead to improved ability to perform daily tasks effectively and efficiently, allowing homemakers to manage chores and responsibilities with greater ease, contributing to their overall well-being and productivity. The incorporation of telerehabilitation empowers homemakers to manage their NP independently, reducing reliance on healthcare professionals and encouraging self-sufficiency and ownership of their health. Telehealth interventions minimise the need for travel and associated carbon emissions, contributing to a more sustainable healthcare system and environment.