Effects of Motor Imagery on Movement-Based Fear in Musculoskeletal Conditions: A Critically Appraised Topic, 2026, Pearcy et al

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voner

Senior Member (Voting Rights)
Effects of Motor Imagery on Movement-Based Fear in Musculoskeletal Conditions: A Critically Appraised Topic

Pearcy, Megan E.; Leonard, Gemma E.; Palfrey, Megan E.; Carroll, Lindsay A.; Bain, Katherine A.

Abstract

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.

Web | DOI | Journal of Sport Rehabilitation
 
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voner said:
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.
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That seems like a pretty low bar to get over..

Looks like physios didn’t manage to fix their basic issues with the trial methodology, so they just made an easy version that everyone could pass.
 
Sean said:
@voner

Could you please add some line breaks in that abstract. Large blocks of text are very difficult to read for many of us.
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@Sean,

my apologies. I know better. I couldn’t read it either. I tried using the "paper formater” software that some nice person (whose name I forgot) here on the forum created to make the process of posting a paper easier and I did not review that mass of text for readability. Thanks for flagging it..
 
Considering that what is referred to as 'fear' mostly translates into being cautious, it seems perfectly reasonable in itself, other than the incorrect framing of this as fear. The entire psychological process here is mostly the avoidance of bad outcomes, including injuries, and avoiding injuries in the context of recovering from an injury seems entirely valid and rational to me.

The whole framing of this as fear screams of insecurity to me. It's needlessly condescending and judgmental in ways that are inappropriate, since there is no real way for an observer to reliably know if it's excessive or not in most cases.

There is a serious need to fix the vocabulary in medicine because too often it gets in the way of what they are trying to accomplish by simply being socially awkward, lacking in basic manners and common decency. This is especially true in everything that clinical psychology has tainted.
Utsikt said:
That seems like a pretty low bar to get over..

Looks like physios didn’t manage to fix their basic issues with the trial methodology, so they just made an easy version that everyone could pass.
Click to expand...
The bar will keep getting lower until the bad evidence appears to be good.
 
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