Abstract
Objective
To determine the effects of a brief single component of the graded motor imagery (GMI)
sequence (mirror therapy) on active range of motion (AROM), pain, fear avoidance,
and pain catastrophization in patients with shoulder pain.
Design
Single-blind case series.
Setting
Three outpatient physical therapy clinics.
Participants
Patients with shoulder pain and limited AROM (N=69).
Intervention
Patients moved their unaffected shoulder through comfortable AROM in front of a mirror
so that it appeared that they were moving their affected shoulder.
Main Outcome Measures
We measured pain, pain catastrophization, fear avoidance, and AROM in 69 consecutive
patients with shoulder pain and limited AROM before and immediately after mirror therapy.
Results
There were significant differences in self-reported pain (P=.014), pain catastrophization (P<.001), and the Tampa Scale of Kinesiophobia (P=.012) immediately after mirror therapy; however, the means did not meet or exceed
the minimal detectable change (MDC) for each outcome measure. There was a significant
increase (mean, 14.5°) in affected shoulder flexion AROM immediately postmirror therapy
(P<.001), which exceeded the MDC of 8°.
Conclusions
A brief mirror therapy intervention can result in statistically significant improvements
in pain, pain catastrophization, fear avoidance, and shoulder flexion AROM in patients
presenting with shoulder pain with limited AROM. The immediate changes may allow a
quicker transition to multimodal treatment, including manual therapy and exercise
in these patients. Further studies, including randomized controlled trials, are needed
to investigate these findings and determine longer-term effects.
Keywords
List of abbreviations:
AROM (active range of motion), CI (confidence interval), CNS (central nervous system), CS (central sensitization), GMI (graded motor imagery), MCID (minimal clinical important difference), MDC (minimal detectable change), PCS (Pain Catastrophization Scale), PNE (pain neuroscience education), TSK (Tampa Scale of Kinesiophobia)To read this article in full you will need to make a payment
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References
- Thinking beyond muscles and joints: therapists' and patients' attitudes and beliefs regarding chronic musculoskeletal pain are key to applying effective treatment.Man Ther. 2013; 18: 96-102
- Exercise for treating fibromyalgia syndrome.Cochrane Database Syst Rev. 2007; : CD003786
- Manipulation or mobilisation for neck pain.Cochrane Database Syst Rev. 2010; : CD004249
- Moving without moving: immediate management following lumbar spine surgery using a graded motor imagery approach: a case report.Physiother Theory Pract. 2015; 31: 509-517
- Immediate effects of sensory discrimination for chronic low back pain: a case series.New Zealand Journal of Physiotherap. 2015; 43: 58-62
- How to explain central sensitization to patients with ‘unexplained’ chronic musculoskeletal pain: practice guidelines.Man Ther. 2011; 16: 413-418
- Recognition of central sensitization in patients with musculoskeletal pain: application of pain neurophysiology in manual therapy practice.Man Ther. 2010; 15: 135-141
- Tactile discrimination, but not tactile stimulation alone, reduces chronic limb pain.Pain. 2008; 137: 600-608
- Central sensitization: uncovering the relation between pain and plasticity.Anesthesiology. 2007; 106: 864-867
- Subgrouping patients with low back pain: evolution of a classification approach to physical therapy.J Orthop Sports Phys Ther. 2007; 37: 290-302
- Proposal of a classification system for patients with neck pain.J Orthop Sports Phys Ther. 2004; 34 (discussion 697-700): 686-696
- Clinical indicators of ‘nociceptive', ‘peripheral neuropathic' and ‘central' mechanisms of musculoskeletal pain. A Delphi survey of expert clinicians.Man Ther. 2009; 15: 80-87
- Mechanisms-based classifications of musculoskeletal pain: Part 1 of 3: Symptoms and signs of central sensitisation in patients with low back (+/-leg) pain.Man Ther. 2012; 17: 336-344
- Pain, the tissues and the nervous system.Physiotherapy. 1998; 84: 27-33
- Graded motor imagery is effective for long-standing complex regional pain syndrome: a randomised controlled trial.Pain. 2004; 108: 192-198
- Graded motor imagery for pathologic pain: a randomized controlled trial.Neurology. 2006; 67: 2129-2134
- Does evidence support physiotherapy management of adult complex regional pain syndrome type one? A systematic review.Eur J Pain. 2009; 13: 339-353
- The effects of graded motor imagery and its components on chronic pain: a systematic review and meta-analysis.J Pain. 2013; 14: 3-13
- Cortical changes in chronic low back pain: current state of the art and implications for clinical practice.Man Ther. 2011; 16: 15-20
- Somatic, motor and sensory representation in the cerebral cortex of man as studied by electrical stimulation.Brain. 1937; 60: 389-448
- The functional organization of the brain in chronic pain.Prog Brain Res. 2000; 129: 313-322
- Temporal dynamics of plastic changes in human primary somatosensory cortex after finger webbing.Cereb Cortex. 2007; 17: 2134-2142
- Extensive reorganisation of primary somatosensory cortex in chronic back pain patients.Neurosci Lett. 1997; 244: 5-8
- Patterns of cortical reorganization in complex regional pain syndrome.Neurology. 2003; 61: 1707-1715
- I can't find it! Distorted body image and tactile dysfunction in patients with chronic back pain.Pain. 2008; 140: 239-243
- Role of distorted body image in pain.Curr Rheumatol Rep. 2007; 9: 488-496
- Distorted body image in complex regional pain syndrome.Neurology. 2005; 65: 773
- Cortical reorganisation and phantom phenomena in congenital and traumatic upper-extremity amputees.Exp Brain Res. 1998; 119: 205-212
- Differences in low back pain behavior are reflected in the cerebral response to tactile stimulation of the lower back.Spine. 2008; 33: 1372-1377
- Bodily illusions in health and disease: physiological and clinical perspectives and the concept of a cortical ‘body matrix'.Neurosci Biobehav Rev. 2012; 36: 34-46
- Disrupted working body schema of the trunk in people with back pain.Br J Sports Med. 2011; 45: 168-173
- Visual distortion of a limb modulates the pain and swelling evoked by movement.Curr Biol. 2008; 18: R1047-R1048
- The graded motor imagery handbook.Noigroup Publications, Adelaide, South Australia2012
- Graded motor imagery for pathologic pain.Neurology. 2006; 67: 1-6
- A controlled pilot study of the utility of mirror visual feedback in the treatment of complex regional pain syndrome (type 1).Rheumatology (Oxford). 2003; 42: 97-101
- Targeting cortical representations in the treatment of chronic pain: a review.Neurorehabil Neural Repair. 2012; 26: 646-652
- The effect of tactile discrimination training is enhanced when patients watch the reflected image of their unaffected limb during training.Pain. 2009; 144: 314-319
- Tactile acuity and lumbopelvic motor control in patients with back pain and healthy controls.Br J Sports Med. 2011; 45: 437-440
- Mirror therapy for phantom limb pain: brain changes and the role of body representation.Eur J Pain. 2014; 18: 729-739
- Mirror therapy in complex regional pain syndrome type 1 of the upper limb in stroke patients.Neurorehabil Neural Repair. 2009; 23: 792-799
- Joining forces - combining cognition-targeted motor control training with group or individual pain physiology education: a successful treatment for chronic low back pain.J Man Manip Ther. 2003; 11: 88-94
- Combined physiotherapy and education is efficacious for chronic low back pain.Aust J Physiother. 2002; 48: 297-302
- Widespread brain activity during an abdominal task markedly reduced after pain physiology education: fMRI evaluation of a single patient with chronic low back pain.Aust J Physiother. 2005; 51: 49-52
- Psychometric properties of the shortened disabilities of the Arm, Shoulder, and Hand Questionnaire (QuickDASH) and Numeric Pain Rating Scale in patients with shoulder pain.J Shoulder Elbow Surg. 2009; 18: 920-926
- A randomized controlled trial of intensive neurophysiology education in chronic low back pain.Clin J Pain. 2004; 20: 324-330
- Evidence for a direct relationship between cognitive and physical change during an education intervention in people with chronic low back pain.Eur J Pain. 2004; 8: 39-45
- The Pain Catastrophizing Scale: development and validation.Psychol Assess. 1995; 7: 524-532
- A psychometric investigation of fear-avoidance model measures in patients with chronic low back pain.J Orthop Sports Phys Ther. 2010; 40: 197-205
- Fear and avoidance of movement in people with chronic pain: psychometric properties of the 11-Item Tampa Scale for Kinesiophobia (TSK-11).Physiother Can. 2012; 64: 235-241
- Psychometric properties of the Fear-Avoidance Beliefs Questionnaire and Tampa Scale of Kinesiophobia in patients with neck pain.Am J Phys Med Rehabil. 2008; 87: 109-117
- The reliability and concurrent validity of shoulder mobility measurements using a digital inclinometer and goniometer: a technical report.Int J Sports Phys Ther. 2012; 7: 306-313
- The reliability and concurrent validity of scapular plane shoulder elevation measurements using a digital inclinometer and goniometer.Physiother Theory Pract. 2012; 28: 161-168
- The reliability, minimal detectable change and construct validity of a clinical measurement for quantifying posterior shoulder tightness in the post-operative population.Int J Sports Phys Ther. 2012; 7: 565-575
- The reliability and minimal detectable change of shoulder mobility measurements using a digital inclinometer.Physiother Theory Pract. 2011; 27: 176-184
- Balancing “hands-on” with “hands-off” physical therapy interventions for the treatment of central sensitization pain in osteoarthritis.Man Ther. 2015; 20: 349-352
- The efficacy of pain neuroscience education on musculoskeletal pain: a systematic review of the literature.Physiother Theory Pract. 2016; 32: 332-355
- Patient education for neck pain.Cochrane Database Syst Rev. 2012; : CD005106
- Impact of the 2005 smoke-free policy in Italy on prevalence, cessation and intensity of smoking in the overall population and by educational group.Addiction. 2012; 107: 1677-1686
- The effect of manual therapy and neuroplasticity education on chronic low back pain: a randomized clinical trial.J Man Manip Ther. 2016 Sep 22; ([Epub ahead of pirnt])
- Listening is therapy: patient interviewing from a pain science perspective.Physiother Theor Pract. 2016; 32: 356-367
Article Info
Publication History
Published online: May 05, 2017
Footnotes
Disclosures: none.
Identification
Copyright
© 2017 by the American Congress of Rehabilitation Medicine
