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Updated: May 12, 2026

Psychophysiological Stress Assessment Using Biofeedback
Published on: July 31, 2009
Psychophysiological responses to a multimodal physiotherapy program in fighter pilots with flight-related neck pain:
Carlos Fernández-Morales1, Luis Espejo-Antúnez1, María de Los Ángeles Cardero-Durán1
1Department of Medical-Surgical Therapy, Faculty of Medicine and Health Sciences, University of Extremadura, Badajoz, Spain.
Background:
The physical and cognitive demands of combat flying may influence the development and persistence of flight-related neck pain (FRNP). The aim of this pilot study was to analyse the effect of a multimodal physiotherapy program which combined supervised exercise with laser-guided feedback and interferential current therapy on psychophysiological variables in fighter pilots with FRNP.
Methods:
Thirty-one fighter pilots were randomly assigned to two groups (Intervention Group: n = 14; Control Group: n = 17). The intervention consisted of 8 treatment sessions (twice per week) delivered over 4 weeks. The following primary outcomes were assessed: perceived pain intensity (Numeric Pain Rating Scale-NPRS) and Heart Rate Variability (HRV; time-domain, frequency-domain and non-linear variables). A number of secondary outcomes were also assessed: myoelectric activity of the upper trapezius and sternocleidomastoid, pain catastrophizing (Pain Catastrophizing Scale-PCS) and kinesiophobia (TSK-11).
Results:
Statistically significant differences (p≤0.05) within and between groups were observed for all outcomes except for frequency domain and non-linear HRV variables. A significant time*group effect (one-way ANOVA) in favour of the intervention group was found for all variables (p<0.001). Effect sizes were large (d≥0.6).
Conclusions:
The use of a multimodal physiotherapy program consisting of supervised exercise with laser-guided feedback and interferential current appears to show clinical benefit in fighter pilots with FRNP.
Trial Registration:
ClinicalTrials.gov: NCT05541848.

