When instructing exercises to improve Range of Motion (ROM), clinicians often create an internal focus of attention, while motor performance may improve more when using an external focus of attention. Using Virtual Reality (VR), we investigated the effect of tasks with an internal and external focus on maximal ROM in people with neck pain and explored whether this effect was associated with fear of movement. Participants’ cervical ROM was measured while performing a target-seeking exercise in a VR-environment (external focus task (EFT)) and during three maximal rotation and flexion-extension movements with the VR-headset on, without signal (internal focus task (IFT)). Questionnaires were used to assess fear of movement. The main statistical analysis included two dependent T-tests. Pearson correlation coefficients were calculated to investigate whether the differences in ROM in both conditions were correlated to fear of movement. Maximum neck rotation was larger in the EFT condition than in the IFT condition (mean (SD) difference: 26.4 (21.4) degrees; p<0.001, r=0.78), but there was a difference in favour of the IFT condition for flexion-extension (mean (SD) difference: 8.2 (24.5) degrees; p=0.018, r=0.32). The variability in ROM was not explained by variability in fear of movement (for all correlations p≥0.197). An external focus resulted in a larger range of rotation, but our flexion-extension findings suggest that the task has to be specific to elicit such an effect. Further research, using a task that sufficiently elicits movement in all directions, is needed to determine the value of an external focus during exercise.

The data set includes raw experimental data of fifty-four people with non-specific neck pain who were recruited from four primary care physiotherapy clinics in the region of Amsterdam and Rotterdam, and at Vrije Universiteit Amsterdam. Participants completed a digital questionnaire to collect personal and neck pain related information regarding age, sex, the duration and onset of their neck pain (gradual or sudden and if sudden, history of trauma), pain intensity, disability, kinesiophobia, fear of physical activity and fear avoidance beliefs. The following questionnaires were used: the Numeric Pain Rating Scale, Neck Disability Index, Tampa Scale of Kinesiophobia and the Fear Avoidance Beliefs Questionnaire. Within a week after completion of the questionnaire the participants performed the VR-experiment to evaluate the effect of an EFT and IFT in a VR environment on maximal cervical range of motion. In addition, we explored whether the size of the effect was associated with the level of kinesiophobia and fear avoidance beliefs. Participants’ cervical ROM was measured while performing a target-seeking exercise in a VR-environment (EFT) and during three maximal rotation and flexion-extension movements with the VR-headset on, without signal (IFT). The furthest maximum and minimum headset position in each direction, respectively around the horizontal (x-axis, flexion-extension) and vertical (y-axis, rotation) was measured. This resulted in four measurements per participant (i.e., rotation EFT, flexion-extension EFT, rotation IFT, flexion-extension IFT). After the VR-experiment, motion sickness was evaluated, using the short version of the Misery Scale (sMISC).