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Effects of Motor Imagery on Movement-Based Fear in Musculoskeletal Conditions: A Critically Appraised Topic
Megan E Pearcy1, Gemma E Leonard1, Megan E Palfrey1
1Shenandoah University, Leesburg, VA, USA.
Clinical Scenario:
The presence of movement-based fear during rehabilitation negatively impacts injury recovery, quality of performance, and perceived disability. While current evidence supports using graded motor imagery (GMI) to reduce movement-based fear in patients with complex regional pain syndrome and chronic neck pain, the effects of GMI on reducing movement-based fear in patients undergoing physical therapy (PT) for an upper- or lower-extremity musculoskeletal injury are unclear.
Clinical Question:
Does incorporating GMI with traditional PT rehabilitation result in decreased movement--based fear compared with traditional PT alone for individuals with an extremity-related musculoskeletal condition?
Methods:
A thorough literature search was conducted in April 2025 to analyze randomized controlled trials. Databases searched include: Cochrane, CINAHL, PubMed, PEDro, and SPORTDiscus. Articles meeting criteria following the title and abstract review were further analyzed using the PEDro scale for quality. Those receiving a score of at least 6/10 were selected for inclusion in this article.
Summary Of Key Findings:
(1) Articles included reported greater improvements in fear-related outcomes among individuals who received GMI treatment compared to traditional PT alone for patients with adhesive capsulitis (Fear Avoidance Beliefs Questionnaire, P = .014), posttraumatic elbow stiffness (Tampa Scale of Kinesiophobia, P = .01), and post-Total Knee Arthroplasty (Tampa Scale of Kinesiophobia, P < .01). (2) Nonmovement-based fear outcome measures, such as shoulder abduction, active range of motion, visual analog scale, Shoulder Pain and Disability Index, and Western Ontario and McMaster Universities Arthritis Index also improved.
Clinical Bottom Line:
GMI combined with traditional PT interventions may be useful for decreasing movement-based fear and improving range of motion, strength, and functional outcomes in patients with frozen shoulder, posttraumatic elbow stiffness, and Total Knee Arthroplasty.
Strength Of Recommendation:
Based on the Strength of Recommendation Taxonomy, a grade of A is recommended based on the quality of evidence provided in the articles included in this Critically Appraised Topic. More research should be conducted to determine optimal treatment parameters for different patient populations.
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