The efficacy of movement representation techniques for treating limb pain – a systematic review and metaanalysis

Relatively new evidence suggests that movement representation techniques, i.e. therapies that use the observation and/or imagination of normal pain-free movements, such as Mirror Therapy, Motor Imagery or Movement/ Action Observation may be effective in reducing some types of limb pain. To summarize the evidence regarding the efficacy of those techniques, a systematic review with metaanalysis was performed. We searched CENTRAL, MEDLINE, EMBASE, CINAHL, AMED, PsychINFO, PEDro and OT-seeker up to August 2014 and handsearched further relevant resources for randomised controlled trials that studied the efficacy of movement representation techniques in reducing limb pain. The outcomes of interest were pain, disability, and quality of life. Study selection and data extraction were performed by 2 reviewers independently. We included 15 trials on the effects of Mirror Therapy, (Graded) Motor Imagery, and Action Observation in patients with Complex Regional Pain Syndrome, Phantom Limb Pain, post-stroke pain, and non-pathological (acute) pain. Overall, movement representation techniques were found to be effective in reducing pain (SMD=-0.82, 95%CI [-1.32…-0.31] p=0.001) and disability (SMD=0.72, 95%CI [0.22…1.22], p=0.004) and showed a positive but non-significant effect on quality of life (SMD=2.61, 85%CI [-3.32…8.54], p=0.39). Especially Mirror Therapy and Graded Motor Imagery should be considered for the treatment of patients with Complex Regional Pain Syndrome.

Furthermore, the results indicate that Motor Imagery could be considered as a potential effective treatment in patients with acute pain after trauma and surgery. To date, there is no evidence for a pain reducing effects of movement representation techniques in patients with Phantom Limb Pain and Post Stroke Pain other than Complex Regional Pain Syndrome.