title: Using graded motor imagery for complex regional pain syndrome in clinical practice: failure to improve pain.
abstract: BACKGROUND
  There is good evidence from studies conducted in a single-centre research setting for the efficacy of graded motor imagery (GMI) treatment, a complex physiotherapy intervention, to reduce pain in long-standing complex regional pain syndrome (CRPS). However, whether GMI is effective in clinical practice is not established.
  
  
  OBJECTIVE
  To establish whether GMI is effective in clinical practice.
  
  
  METHODS
  We undertook a prospective audit of GMI treatment at two UK centres with a special interest in the management of patients with CRPS. All patients received GMI, in conjunction with a range of other 'best practice' physical and psychological interventions.
  
  
  RESULTS
  The patients' average pain intensities did not improve with treatment [centre 1: n = 20, pre-post numeric rating scale (NRS) difference 0.6 [confidence interval (CI) -0.3 to 1.5]; centre 2: n = 12, pre-post NRS difference 0.2 (CI: -0.9 to 1.2)]. Patients at centre 1 reported significant functional improvement. Improved performance on left/right judgement replicated in both centres seen in the clinical trials.
  
  
  CONCLUSIONS
  The failure of our real-world implementation of GMI suggests that better understanding of both the GMI methodology and its interaction with other treatment methods is required to ensure that GMI research results can be translated into clinical practice. Our results highlight challenges with the translation of complex interventions for chronic pain conditions into clinical practice.
authors.affiliation: The Walton Centre NHS Foundation Trust, Liverpool, L9 7LJ, UK.
authors.forename: S
authors.initials: S
authors.lastname: Johnson
authors.forename: J
authors.initials: J
authors.lastname: Hall
authors.forename: S
authors.initials: S
authors.lastname: Barnett
authors.forename: M
authors.initials: M
authors.lastname: Draper
authors.forename: G
authors.initials: G
authors.lastname: Derbyshire
authors.forename: L
authors.initials: L
authors.lastname: Haynes
authors.forename: C
authors.initials: C
authors.lastname: Rooney
authors.forename: H
authors.initials: H
authors.lastname: Cameron
authors.forename: G L
authors.initials: GL
authors.lastname: Moseley
authors.forename: A C
authors.initials: AC
authors.lastname: de C Williams
authors.forename: C
authors.initials: C
authors.lastname: McCabe
authors.forename: A
authors.initials: A
authors.lastname: Goebel
mesh_terms: D000328:Adult; D000339:Affect; D002422:Causalgia / Q000175:diagnosis / Q000523:psychology / Q000628:therapy; D020918:Complex Regional Pain Syndromes / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D016001:Confidence Intervals; D004185:Disability Evaluation; D023381:Endpoint Determination; D005260:Female; D007839:Functional Laterality / Q000502:physiology; D006801:Humans; D019018:Imagery, Psychotherapy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D059408:Pain Management / Q000379:methods*; D010147:Pain Measurement; D011446:Prospective Studies; D011597:Psychomotor Performance; D011930:Reaction Time; D012019:Reflex Sympathetic Dystrophy / Q000175:diagnosis / Q000523:psychology / Q000628:therapy; D017211:Treatment Failure; D055815:Young Adult