Effects of eye movement exercise combined with conventional physical therapy on chronic nonspecific neck pain: a randomized controlled trial protocol

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Introduction Chronic nonspecific neck pain (CNNP) is a prevalent and disabling musculoskeletal disorder frequently accompanied by cervical sensorimotor deficits and autonomic nervous system (ANS) dysregulation while conventional physical therapy (CPT) can reduce pain and disability, its effects are often limited in autonomic nerve system dysfunction. Eye movement exercise (EME) engages oculomotor–vestibular–proprioceptive networks and stimulates vagal-parasympathetic pathways, offering potential synergistic benefits. However, clinical evidence supporting an EME-integrated rehabilitation regimen in CNNP is scarce. This trial aims to evaluate the efficacy of EME + CPT compared to CPT alone on relieving pain intensity, disability intensity, autonomic regulation, and quality of life for CNNP. Methods A single-centre, assessor-blinded randomized controlled trial will recruit 60 adults with CNNP ≥12 weeks. Participants will be randomly assigned (1:1) to either CPT alone or CPT + EME group. Interventions will be administered three times per week for four consecutive weeks (about 60 min per session). The primary outcome is pain intensity (measured using a 100-mm visual analogue scale, VAS). The prespecified primary endpoint is Day 30, and the primary treatment contrast is the between-group difference in mean change in VAS from baseline to Day 30. Secondary outcomes include neck disability index, cervical active range of motion, anxiety and depression severity and health-related quality of life. Heart rate variability (HRV) is prespecified as a secondary mechanistic outcome, whereas oculomotor performance and electrical sensory/pain thresholds, and eye movement accuracy are exploratory outcomes. Data will be collected at baseline, Day 15, and Day 30. The primary analysis will use a linear mixed-effects model under the intention-to-treat principle. Discussion This trial will clarify whether integrating structured EME into a standard rehabilitation framework confers incremental short-term clinical benefits over conventional therapy of equal total duration. Exploratory autonomic and oculomotor endpoints will provide insight into underlying physiological associations rather than inferring direct causality, informing future large-scale, long-term rehabilitation trials. Clinical Trial Registration https://www.chictr.org.cn/bin/project/edit?pid=293180 , identifier ChiCTR2500111782.