OBJECTIVES: To investigate the effect of telerehabilitation-based graded motor imagery (MI, GMI) training on pain and pain-related factors in people with multiple sclerosis (MS).
DESIGN: Randomized controlled, assessor-blind pilot trial with repeated-measure design.
SETTING: Neurology outpatient clinic.
PARTICIPANTS: Thirty-two people with MS were randomly allocated to intervention (n=16) and control (n=16) groups.
INTERVENTIONS: During the 8-week GMI training period, the first 2 weeks involved implicit MI training while 6 weeks of explicit MI training were conducted.
MAIN OUTCOME MEASURES: The primary outcome was the general pain intensity over the past 2 days, assessed with a visual analog scale, with a minimum clinically important difference (MCID) of 23 mm. Secondary outcomes included general pain and specific body parts' pain intensity over the past 7 days, neuropathic pain intensity, MI ability, fatigue, depression, anxiety, quality of life, sleep quality, daytime sleepiness, and cognitive functions scores. Assessments were conducted at baseline, at weeks 8 (post-treatment) and 12 (follow-up).
RESULTS: The intervention group demonstrated a significant reduction in pain intensity over the past 2 days compared with control group (P<.05). Furthermore, at the 8-week assessment, the intervention group surpassed the MCID in pain intensity over the past 2 and 7 days (P<.05), whereas no significant change was observed in the control group (P>.05). Significant effects were observed post-treatment on general pain over the past 7 days, neuropathic pain, MI ability, fatigue, depression, quality of life, processing speed, and visuospatial memory within intervention group compared with control group (P<.05). However, the effect on anxiety, sleep quality, daytime sleepiness, and verbal memory between groups was not significant (P>.05).
CONCLUSIONS: Telerehabilitation-based GMI training stands out as viable for the management of chronic pain and pain-related psychosocial symptoms for people with MS.
| Discipline Area | Score |
|---|---|
| Rehab Clinician (OT/PT) |  |
Rehab Clinician (OT/PT) rater
This study had a novel approach to pain management in patients with MS. Because it included only patients with MS, it presented a very narrow range of applicability considering the greater population of patients with chronic pain. The primary outcome of pain measured over the past two days was a very short range, but there were a large number of secondary outcomes that helped to offset the narrow range of the primary outcome. Any improvements that were gained in pain reduction were not sustained past the 12-week mark, thus making the treatment not particularly valuable in real life.
, McMaster University