Running title: Effect of graded motor imagery on chronic pain
Indexing words:Graded motor imagery, GMI, mirror therapy, motor imagery left/right judgements, chronic pain, systematic review 2
AbstractGraded motor imagery (GMI) is becoming increasingly used in the treatment of chronic pain conditions. The objective of this systematic review was to synthesise all evidence concerning the effects of GMI and its constituent components on chronic pain. Systematic searches were conducted in 10 electronic databases. All randomised controlled trials (RCTs) of GMI, left/right judgement training, motor imagery, and mirror therapy used as a treatment for chronic pain were included.Methodological quality was assessed using the Cochrane risk of bias tool. Six RCTs met our inclusion criteria and the methodological quality was generally low. No effect was seen for left/right judgement training and conflicting results were found for motor imagery used as stand-alone techniques, but positive effects were observed for both mirror therapy and GMI. A meta-analysis of GMI versus usual physiotherapy care favoured GMI in reducing pain (2 studies, n = 63; effect size 1.06 (0.41, 1.71); heterogeneity, I 2 = 15%). Our results suggest that GMI and mirror therapy alone may be effective although this conclusion is based on limited evidence. Further rigorous studies are needed to investigate the effects of GMI and its components on a wider chronic pain population.Perspective: This systematic review synthesises the evidence for GMI and its constituent components on chronic pain. This review may assist clinicians in making evidence-based decisions on managing patients with chronic pain conditions.