Comparison of the Effect of six Weeks of Dynamic Neuromuscular Stabilization (DNS) Exercise with and without the Use of Virtual Reality (VR) on pain, Balance, Proprioception, Range of Motion and Lumbar Arch Degree in Middle-aged Women with Hyperlordosis with nonspecific chronic low back pain: A randomized clinical trial

Comparison of the effects of a six-week Dynamic Neuromuscular Stabilization (DNS) exercise program—with and without Virtual Reality (VR)—on pain intensity, balance, proprioception, range of motion, and lumbar curvature in middle-aged women with lumbar hyperlordosis and chronic nonspecific low back pain.

Randomized, parallel, three-arm, open-label clinical trial (Phase: Not Applicable / Rehabilitation) with a sample size of 50. Randomization was done by lot drawing in blocks of three, and allocation was concealed using sealed opaque envelopes.

The study was conducted at Shahid Beheshti University in Tehran on women aged 30–50 with hyperlordosis and chronic low back pain. Exercise interventions were delivered over six weeks at the university rehabilitation gym. Pre- and post-intervention assessments, six weeks apart, were performed to measure pain (VAS), lumbar lordosis, balance, proprioception, and range of motion. No blinding was implemented.

1.Women aged 30 – 50 years 2.No history of spinal fracture,or joint disease 3.Lumbar lordosis greater than 40 degrees 4.Body-mass index (BMI) between 18.5 and 27 5.No use of orthotic insoles, a cane, some drugs 6.Pain intensity between 3-7 on the Visual Analogue Scale (VAS) 7.No related pathological signs 8.No orthopedic deformities or neurosurgical disorders 10.No surgery or pregnancy in the past 30 days

1.Group receiving Dynamic Neuromuscular Stabilization (DNS) exercises with a virtual-reality device (DNS + VR). 2.Group receiving Dynamic Neuromuscular Stabilization (DNS) exercises without a virtual-reality device (DNS-only).

Change in low-back pain intensity and in lumbar lordosis angle by the end of the 6-week intervention.

Sequence Generation To keep an equal 1 : 1 : 1 allocation across the three study arms— Group A = DNS exercise only Group B = DNS + virtual-reality (VR) exercise Group C = no-treatment control I first divide the total sample size n into three equal parts (n / 3 per group). Then I prepare n / 3 identical paper slips marked “A”, n / 3 slips marked “B”, and n / 3 slips marked “C.” All slips are folded twice so the label cannot be seen, placed together in a single opaque, non-transparent container, and thoroughly mixed before recruitment begins. For each eligible participant I (or an independent staff member) draw one slip blindly from the container. The letter on the slip immediately determines that participant’s assignment. After a slip is drawn it is removed from the pool and stored separately, so the remaining probabilities stay constant (sampling without replacement).

The shared data may include de-identified demographic variables, primary outcome data, and selected secondary outcomes. All shared datasets will be fully anonymized in accordance with confidentiality standards. Data will only be shared upon formal request and with approval by the ethics committee or relevant authorities. Public release of the full dataset is not planned at this stage, but specific outcome data may be included in future publications, following ethical guidelines.

Access to aggregated, de-identified outcome data will begin approximately a few months after the publication of final results in a scientific article or thesis. Only summarized data will be publicly available through publications. No direct access to raw individual participant data is planned.

Access to the study data and documents is limited to the principal investigator, research team members, academic supervisor, and, if necessary, the Ethics Committee of Shahid Beheshti University. Other individuals will only have access to aggregated and analyzed results published in the thesis or scientific articles. No direct access to raw data is planned for the public or external researchers.

The data and documents from this study may only be used for research and educational purposes, in full compliance with ethical research principles, data confidentiality, and non-disclosure of participants' identities. Usage is limited to the results presented in the thesis or scientific publications. No access to raw data is permitted for third parties.

Any requests for access to the data or documents related to this study must be formally submitted in writing to the principal investigator or the academic supervisor at the Faculty of Physical Education, Shahid Beheshti University. Approval from the university’s Research Ethics Committee may also be required, depending on the nature of the request.

in the event of receiving a formal request for access to the study’s data or documents, the request will first be reviewed by the principal investigator or the academic supervisor. If the nature of the request involves access to unpublished or ethically sensitive information, it will be referred to the Research Ethics Committee of Shahid Beheshti University for final approval.