title: The Efficacy of Movement Representation Techniques for Treatment of Limb Pain--A Systematic Review and Meta-Analysis.
abstract: Relatively new evidence suggests that movement representation techniques (ie, therapies that use the observation and/or imagination of normal pain-free movements, such as mirror therapy, motor imagery, or movement and/or action observation) might be effective in reduction of some types of limb pain. To summarize the evidence regarding the efficacy of those techniques, a systematic review with meta-analysis was performed. We searched Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CINAHL, AMED, PsychINFO, Physiotherapy Evidence Database, and OT-seeker up to August 2014 and hand-searched further relevant resources for randomized controlled trials that studied the efficacy of movement representation techniques in reduction of 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, poststroke pain, and nonpathological (acute) pain. Overall, movement representation techniques were found to be effective in reduction of pain (standardized mean difference [SMD] = -.82, 95% confidence interval [CI], -1.32 to -.31, P = .001) and disability (SMD = .72, 95% CI, .22-1.22, P = .004) and showed a positive but nonsignificant effect on quality of life (SMD = 2.61, 85% CI, -3.32 to 8.54, P = .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 effect of movement representation techniques in patients with phantom limb pain and poststroke pain other than complex regional pain syndrome.
  
  
  CONCLUSIONS
  In this systematic review we synthesize the evidence for the efficacy of movement representation techniques (ie, motor imagery, mirror therapy, or action observation) for treatment of limb pain. Our findings suggest effective pain reduction in some types of limb pain. Further research should address specific questions on the optimal type and dose of therapy.
authors.affiliation: Faculty of Social Work and Health, University of Applied Sciences and Arts, Hildesheim, Germany; First European School for Physiotherapy, Occupational Therapy, and Speech and Language Therapy, Clinic Bavaria Kreischa, Kreischa, Germany. Electronic address: holm.thieme@hawk-hhg.de.
authors.forename: Holm
authors.initials: H
authors.lastname: Thieme
authors.affiliation: MEDIAN Clinic Berlin-Kladow, Berlin, Germany; Center for Stroke Research Berlin, Charité - University Medicine Berlin, Berlin, Germany.
authors.forename: Nadine
authors.initials: N
authors.lastname: Morkisch
authors.affiliation: Department of Special Education and Rehabilitation, Faculty of Human Sciences, University of Cologne, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Rietz
authors.affiliation: MEDIAN Clinic Berlin-Kladow, Berlin, Germany; Center for Stroke Research Berlin, Charité - University Medicine Berlin, Berlin, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Dohle
authors.affiliation: Faculty of Social Work and Health, University of Applied Sciences and Arts, Hildesheim, Germany.
authors.forename: Bernhard
authors.initials: B
authors.lastname: Borgetto
mesh_terms: D005121:Extremities / Q000503:physiopathology*; D006801:Humans; D007092:Imagination; D009043:Motor Activity; D000066530:Neurological Rehabilitation / Q000379:methods*; D017063:Outcome Assessment, Health Care; D059408:Pain Management / Q000379:methods*
keywords: Movement representation techniques; action observation; complex regional pain syndrome; limb pain; mirror therapy; motor imagery; phantom limb pain; poststroke pain