Original article
An Integrated Motor Imagery Program to Improve Functional Task Performance in Neurorehabilitation: A Single-Blind Randomized Controlled Trial

https://doi.org/10.1016/j.apmr.2010.03.008Get rights and content

Abstract

Bovend'Eerdt TJ, Dawes H, Sackley C, Izadi H, Wade DT. An integrated motor imagery program to improve functional task performance in neurorehabilitation: a single-blind randomized controlled trial.

Objective

To investigate the feasibility of a motor imagery program integrated into physiotherapy and occupational therapy.

Design

A parallel-group, phase II, assessor-blind randomized controlled trial comparing motor imagery embedded in usual therapy with usual therapy only.

Setting

A neurologic rehabilitation center (Oxford, United Kingdom).

Participants

Inpatients and outpatients diagnosed with stroke, brain injury, or multiple sclerosis, participating in a rehabilitation program with sufficient language skills to undertake the intervention were recruited (N=30) and assessed at baseline, after 6 weeks (postintervention), and after 12 weeks (follow-up).

Interventions

A motor imagery strategy was developed that could be integrated into usual therapy, tailored to individual goals, and used for any activity. The control group received standard care.

Main Outcome Measures

Goal attainment scaling was used as the primary outcome measure. Other measures included the Barthel activities of daily living index and the Rivermead Mobility Index.

Results

Compliance with advised treatment was poor in 85% of the therapists and in 72% of the patients. Goal attainment scaling scores significantly improved at postintervention and follow-up (F2,27=45.159; P<.001), but no significant difference was observed between the groups over time (F1,28=.039; P=.845).

Conclusions

Therapist and patient compliance with performing the intervention was low, restricting the conclusions regarding the effectiveness of the integrated motor imagery program. Future studies will need to explore barriers and facilitators to uptake of this intervention in clinical practice. Trial recruitment and retention were good. The study demonstrated that imagery could be successfully integrated into usual therapy and tailored for a wide range of functional activities.

Section snippets

Methods

This was a phase II exploratory RCT with masked assessment and 2 parallel groups. Both groups received task-specific physiotherapy and occupational therapy provided by their own therapists, as usual. Patients in the experimental group were additionally taught how to incorporate motor imagery into usual therapy and into activities practiced outside therapy. This teaching was undertaken within the allocated treatment time (ie, there was no additional therapy contact time). Patients in the control

Results

Patients were recruited from the Oxford Centre for Enablement between February 14, 2008, and January 15, 2009. Figure 1 presents the Consolidated Standards of Reporting Trials flowchart for this study. Of the 77 admitted patients, 7 refused to participate, 1 was uncooperative because of cognitive problems, 34 patients did not fulfill the criteria (14 did not fulfill the criteria for diagnosis; 17 could not complete the Sheffield screening test; 2 did not speak English; 1 was younger than 18y).

Discussion

The study demonstrated low compliance of the therapist and patient with performing motor imagery. As such, we cannot draw conclusions regarding the efficacy of integrating imagery into usual therapy. Future studies will need to explore barriers and facilitators to uptake of this intervention into clinical practice. However, it did show that motor imagery could be successfully integrated into usual therapy and tailored for a range of functional activities (ie, when motor imagery was actually

Conclusions

The novelty of this study compared with the other motor imagery studies is that the treatment involved teaching a strategy to the patient by therapists, rather than focusing on 1 particular task. In principle, teaching a strategy should be more effective and efficient because it can be used to help with many problems. However, our results suggest that we did not teach it very successfully—the patients who received training were no more confident at imagery after training than the control

Acknowledgments

We thank the patients and the therapists at the Oxford Centre for Enablement, Charlotte Winward and Emad El-Yahya for their help in this study, and Joan Warren for her financial support.

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    Financial support by Joan Warren (private charity trust).

    No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.

    Clinical trial registration number: NCT00618.

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