Persistence of Structural Reasoning in Brazilian Physiotherapy: A Cross-Sectional Study on 'Text Neck' Beliefs

The 'text neck' concept-that sustained cervical flexion during mobile device use causes mechanical overload, pain, and dysfunction-has gained popularity among physiotherapists despite limited empirical evidence. This belief may perpetuate outdated kinesiopathological reasoning that conflicts with biopsychosocial approaches.

To assess the prevalence of 'text neck' beliefs in a recruited sample of Brazilian physiotherapists and examine their association with kinesiopathological clinical reasoning.

This cross-sectional observational study invited physiotherapists to complete an online questionnaire addressing clinical reasoning in both acute and chronic neck pain scenarios. The Chi-square (χ²) goodness-of-fit test was used to assess differences in category distributions, and the Chi-square test of independence was used to examine associations between categorical variables. Logistic regression models were developed to investigate the influence of educational level, professional specialisation in areas related to neck pain management, and time since graduation on the odds of employing kinesiopathological reasoning.

Most physiotherapists endorsed assessing and treating neck pain based on smartphone postural parameters and the kinesiopathological model (e.g., 73% for acute neck pain; 66% for chronic neck pain). Chi-square tests showed significant moderate associations between 'text neck' beliefs and kinesiopathological reasoning (Cramér's V = 0.31-0.40, p < 0.001). Higher educational level was associated with a 30% reduction in odds of employing kinesiopathological reasoning (OR = 0.70; 95% CI [0.56, 0.90], p = 0.003).

Despite increasing endorsement of biopsychosocial models, a substantial proportion of physiotherapists in this sample reported employing 'text neck' concepts and kinesiopathological reasoning. Higher educational attainment was associated with reduced reliance on these approaches, highlighting the need for targeted educational reforms to promote evidence-based clinical reasoning.