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The efficacy of graded motor imagery in post-traumatic stiffness of elbow: a randomized controlled trial
Birinci T, Mutlu EK, Altun S
Journal of Shoulder and Elbow Surgery 2022 Oct;31(10):2147-2156
clinical trial
8/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: Yes; Adequate follow-up: Yes; Intention-to-treat analysis: Yes; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

BACKGROUND: Physiotherapy improves the movement range after the onset of post-traumatic elbow stiffness and reduces the pain, which is a factor limiting elbow range of motion. However, no results have been reported for motor-cognitive intervention programs in post-traumatic elbow stiffness management. The objective was to investigate the efficacy of Graded Motor Imagery (GMI) in post-traumatic elbow stiffness. METHODS: Fifty patients with post-traumatic elbow stiffness (18 female; mean age 41.9 +/- 10.9 years) were divided into two groups. The GMI group (n = 25) received a program consisting of left/right discrimination, motor imagery, and mirror therapy (twice a week for six weeks); the structured exercise (SE) group (n = 25) received a program consisting of the range of motion, stretching, and strengthening exercises (twice a week for six weeks). Both groups received a 6-week home exercise program. The primary outcome was the Disabilities of the Arm, Shoulder and Hand (DASH). The secondary outcomes were the active range of motion (AROM), Visual Analogue Scale (VAS), Tampa Scale for Kinesiophobia (TSK), muscle strength of elbow flexors and extensors, grip strength, left/right discrimination, and Global Rating of Change. Patients were assessed at baseline, at the end of treatment (12 sessions), and a 6-week follow-up. RESULTS: The results indicated that both GMl and SE interventions significantly improved outcomes (p < 0.05). After a 6-week intervention, the DASH score was significantly improved with a medium effect size in the GMI group compared to the SE group and improvement continued at the 6-week follow-up (F1,45 = 3.10, p = 0.01). The results with a medium to large effect size were also significant for elbow flexion AROM (p = 0.02), elbow extension AROM (p = 0.03), VAS-activity (p = 0.001), TSK (p = 0.01), muscle strength of elbow flexors and elbow extensors (p = 0.03) in favor of GMI group. CONCLUSION: The GMI is an effective motor-cognitive intervention program that might be applied to the rehabilitation of post-traumatic elbow stiffness to improve function, elbow AROM, pain, fear of movement-related pain, and muscle strength.

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