Motor imagery for pain and motor function after spinal cord injury: a systematic review

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Abstract

Study design

Systematic review.

Objectives

To evaluate the therapeutic benefits of motor imagery (MI) for the people with spinal cord injury (SCI).

Setting

International.

Methods

We searched electronic bibliographic databases, trial registers, and relevant reference lists. The review included experimental and quasi-experimental study designs as well as observational studies. For the critical appraisal of the 18 studies retrieved (three RCT, seven quasi-RCT, eight observational), we used instruments from the Joanna Briggs Institute. The primary outcome measure was pain. Secondary outcome measures included motor function and neurophysiological parameters. Adverse effects were extracted if reported in the included studies. Because of data heterogeneity, only a qualitative synthesis is offered.

Results

The included studies involved 282 patients. In most, results were an improvement in motor function and decreased pain; however, some reported no effect or an increase in pain. Although protocols of MI intervention were heterogeneous, sessions of 8–20 min were used for pain treatments, and of 30–60 min were used for motor function improvement. Neurophysiological measurements showed changes in brain region activation and excitability imposed by SCI, which were partially recovered by MI interventions. No serious adverse effects were reported.

Conclusions

High heterogeneity in the SCI population, MI interventions, and outcomes measured makes it difficult to judge the therapeutic effects and best MI intervention protocol, especially for people with SCI with neuropathic pain. Further clinical trials evaluating MI intervention as adjunct therapy for pain in SCI patients are warranted.

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Fig. 1
Fig. 2: Forests plots presenting the results of studies investigating the effect of motor imagery (MI) interventions on pain intensity in individuals with spinal cord injury.

Data availability

The datasets generated during the current study are available from the corresponding author upon request.

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Funding

The study was in part supported by a grant from the University of Applied Sciences and Arts Western Switzerland//HES-SO (scientific commission of health) to Emmanuelle Opsommer (73642/S-RAD17–04).

Author information

EOP and NKO were responsible for designing the review protocol, writing the protocol and report, conducting the search, and screening potentially eligible studies. EOP, OCH, and NKO were responsible for critically appraising studies, extracting and analyzing data, and interpreting results, updating reference lists, creating Summary of findings’ tables, and writing the final report.

Correspondence to Emmanuelle Opsommer.

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Opsommer, E., Chevalley, O. & Korogod, N. Motor imagery for pain and motor function after spinal cord injury: a systematic review. Spinal Cord (2019) doi:10.1038/s41393-019-0390-1

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