Motor Imagery Training in Non-Specific Low Back Pain

Low back pain is a significant global health issue, affecting a large proportion of the population at some point in their lives. Among the different types of low back pain, non-specific low back pain is the most common. Chronic low back pain has been shown to impact trunk endurance, functional capacity, fatigue, anxiety, and depression levels.

Neuroscience-based studies aimed at improving pain management have demonstrated that chronic pain is associated with not only peripheral changes but also central changes. These central changes include abnormalities in the distribution of sensory cortical processing, disinhibition of the motor cortex, and disturbances in body schema perception.

Studies have shown that motor imagery training, defined as the mental simulation of movement without actual execution, functions as a cortical-level training method and has positive effects on impaired body schema perception, thereby reducing pain. A review of the literature indicates that motor imagery training contributes to the treatment of pathological pain syndromes such as complex regional pain syndrome, brachial plexus avulsion injury, phantom limb pain, distal radius fracture, and stroke by modulating cortical mechanisms. However, no randomized controlled trials have investigated the effectiveness of adding motor imagery training to exercise therapy in individuals with non-specific chronic low back pain, specifically regarding its impact on physical function and psychosocial parameters.

The aim of this study is to investigate the effects of a motor imagery training protocol, applied in addition to exercise therapy, on pain, physical, and psychosocial parameters in individuals with non-specific chronic low back pain.

A total of 32 individuals with chronic non-specific low back pain will be included in the study. Participants will be randomly assigned to either the intervention or control group. All participants will receive telerehabilitation-based exercise therapy under the supervision of a physiotherapist. In addition to the exercise therapy, participants in the intervention group will undergo asynchronous motor imagery training every day for eight weeks, while the control group will receive only exercise therapy.

Assessments will be conducted three times: before treatment, at the end of the 8-week intervention, and at the 12th week follow-up. All assessments will be performed through a telerehabilitation-based approach. The study will evaluate participants' pain, fatigue, disability level due to low back pain, anxiety and depression levels, and physical function.


Eligibility Criteria:
Inclusion Criteria:

* Being between 18 and 55 years old
* Having a history of low back pain persisting for at least three months
* Experiencing recurrent episodes of low back pain
* Having a low back pain intensity score of 4 or higher on the Numeric Pain Rating Scale (NRS) out of 10 during both rest and activity
* Having the ability to use a computer, tablet, or smartphone at a level sufficient to participate in assessments and treatment sessions via videoconference, or having a caregiver who can assist with this
* Volunteering to participate in the study
* Being able to read and understand Turkish

Exclusion Criteria:

* A history of spinal surgery
* Having traumatic low back injuries
* Presence of severe comorbidities (neurological, neuromuscular, cardiological, psychiatric)
* Presence of tumoral conditions
* Having visual or hearing impairments
* Presence of cognitive impairments
* Receiving physiotherapy for low back pain within the last six months
* Changes in pain medication within the last two months
* Receiving additional treatments beyond routine care
* Being pregnant