title: The effects of graded motor imagery and its components on chronic pain: a systematic review and meta-analysis.
abstract: Graded motor imagery (GMI) is becoming increasingly used in the treatment of chronic pain conditions. The objective of this systematic review was to synthesize all evidence concerning the effects of GMI and its constituent components on chronic pain. Systematic searches were conducted in 10 electronic databases. All randomized controlled trials (RCTs) of GMI, left/right judgment training, motor imagery, and mirror therapy used as a treatment for chronic pain were included. Methodological quality was assessed using the Cochrane risk of bias tool. Six RCTs met our inclusion criteria, and the methodological quality was generally low. No effect was seen for left/right judgment training, and conflicting results were found for motor imagery used as stand-alone techniques, but positive effects were observed for both mirror therapy and GMI. A meta-analysis of GMI versus usual physiotherapy care favored GMI in reducing pain (2 studies, n = 63; effect size, 1.06 [95% confidence interval, .41, 1.71]; heterogeneity, I(2) = 15%). Our results suggest that GMI and mirror therapy alone may be effective, although this conclusion is based on limited evidence. Further rigorous studies are needed to investigate the effects of GMI and its components on a wider chronic pain population.
  
  
  CONCLUSIONS
  This systematic review synthesizes the evidence for GMI and its constituent components on chronic pain. This review may assist clinicians in making evidence-based decisions on managing patients with chronic pain conditions.
authors.affiliation: Sansom Institute for Health Research, University of South Australia, Adelaide, South Australia, Australia.
authors.forename: K Jane
authors.initials: KJ
authors.lastname: Bowering
authors.forename: Neil E
authors.initials: NE
authors.lastname: O'Connell
authors.forename: Abby
authors.initials: A
authors.lastname: Tabor
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Catley
authors.forename: Hayley B
authors.initials: HB
authors.lastname: Leake
authors.forename: G Lorimer
authors.initials: GL
authors.lastname: Moseley
authors.forename: Tasha R
authors.initials: TR
authors.lastname: Stanton
mesh_terms: D059350:Chronic Pain / Q000628:therapy*; D003627:Data Interpretation, Statistical; D007839:Functional Laterality / Q000502:physiology; D006801:Humans; D019018:Imagery, Psychotherapy / Q000379:methods*; D017594:Publication Bias; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome