Clinical trial NCT06502236: Motor Imagery Ability and Cervical Discogenic Pain
Official title: Motor Imagery Ability and Its Relationship With Pain, Functional Status, Neck Awareness and Depression Levels in Individuals With Cervical Discogenic Pain
Study type: OBSERVATIONAL
Overall status: COMPLETED
Conditions: Motor Imagery
Neck Pain
Disc Herniation
Functional Status
Keywords: Awareness
Endurance
Functional Status
Motor Imagery
Neck
Pain
Lead sponsor: Hacettepe University
Sponsor class: OTHER
First posted: 2024-07-16
Enrollment: 60
Sex: ALL
Minimum age (years): 18
Maximum age (years): 65
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: yes
Observational model: COHORT
Time perspective: CROSS_SECTIONAL
Sampling method: PROBABILITY_SAMPLE
Study population: The present study was conducted with individuals aged 18 to 65 years with cervical disc herniation, who were suffered from neck pain lasting for at least 3 months, had a resting pain between 3-7 according to the Visual Analog Scale and could follow the instructions of a physiotherapist. All individuals initially diagnosed as cervical disc lesion either one level or multilevel lesions, as diagnosed by the neurologist and confirmed by MRI imaging. The individuals with disk degeneration without cervical disk herniation, cervical stenosis and cervical spondylosis were excluded.

Brief summary: Background: The purpose of the study was to examine the motor imagery ability and its association with pain, functional status, neck awareness and depression levels in individuals with cervical discogenic pain (CDP).

Methods: Sixty individuals aged between 18-65 were included in the study. Demographic data was recorded, pain and disability were evaluated using Visual Analogue Scale (VAS) and Neck Disability Index (NDI), motor imagery ability using Kinesthetic and Visual Imagery Questionnaire-20 (KVIQ-20) and mental chronometry. Grip strength, cervical muscle endurance, upper limbs functionality, neck awareness and depression levels were assessed using hydraulic hand dynamometer, cervical muscle endurance tests, Upper Extremity Functional Index-15 (UEFI-15), Fremantle Neck Awareness Questionnaire (FreNAQ), and Beck Depression Inventory (BDI), respectively.

Detailed description: Motor imagery (MI) is defined as the cognitive representation of a body movement without the actual movement. MI depends on both kinesthetic - which require sensory-motor knowledge- and visual strategies - which require visual knowledge of the movement imagined. Kinesthetic MI is the ability to visualize a movement simulation to perceive its direction, speed, and magnitude. This ability requires the activation of neurocognitive mechanisms that underlie the design and execution of voluntary movement. Visual motor imagery occurs through internal or external visual imagery. Internal visual imagery involves visualizing a movement from ones own perspective, while external visual imagery involves seeing a movement from a third persons perspective. Neuroimaging studies revealed that the parts of the brain activating during MI were similar to those which activate while a movement was actually performed. Therefore, activating joint and muscle receptors by MI may increase corticomotor excitability. Moreover, it was demonstrated that subcortical structures were activated through excitability of presynaptic interneurons by MI, i.e. without activating alpha-motor neurons. Activation through MI ensures continuity of movement and improves the quality of desired movements, playing a key role in enhancing motor function and performance.

Individuals with cervical disc pathologies exhibit a reduced fiber density along the corticospinal tract. Functional magnetic resonance imaging studies have shown increased activation in the primary motor and premotor cortices and a loss of activation in the sensory cortex. These changes are related to the severity of the disc pathology. Besides, it was reported that prolonged compression in the cervical spine might lead to atrophy in the sensorimotor cortex and thalamus, giving rise to a functional reorganization, usually result in maladaptive neuroplasticity. Chronic pain, a common finding in cervical disc pathologies, may affect the perception of painful body parts and MI performance, as well as impaired somatotopic representation. In addition to cortical changes, the gradual processing of stimuli by mirror neurons, which generate motor movements, is considered a significant component of learning by imitation and observation. This process forms an important part of MI and is thought to be impaired in individuals with chronic pain. They highlighted that evaluating the MI ability of an individual with chronic neck pain was important for revealing the mental imagery performance.

In individuals with chronic neck pain, it was revealed that the severity of pain and the functional and psychosocial problems caused by the pain, were related to executive functions and working memory. They discovered that MI depends on executive functions. Interference tasks significantly affect the timing of MI. Therefore, it is believed that pain-related symptoms will also negatively impact MI skills. In the literature, studies have demonstrated positive effects of MI training on pain, disability, and fear of movement in individuals with chronic pain. However, it is suggested that factors related to MI ability should be further investigated. Therefore, the purpose of the study was to examine the relationships between MI ability and pain, functional status, neck awareness and depression levels in individuals with cervical discogenic pain (CDP).

Eligibility criteria: Inclusion Criteria:

* Aged 18 to 65 years with cervical disc herniation, who were suffered from neck pain lasting for at least 3 months,
* Had a resting pain between 3-7 according to the Visual Analog Scale;
* Could follow the instructions of a physiotherapist.

Exclusion Criteria:

* The individuals with disk degeneration without cervical disk herniation, cervical stenosis and cervical spondylosis were excluded.
* In addition, individuals who had a history of spinal tumor or head trauma, had a spinal deformity or congenital malformation, had a cervical instability and cervical artery dysfunction, underwent any cervical surgery in the preceding 6 months, musculoskeletal disorders and neuromuscular diseases in the upper extremity and shoulders (rotator cuff tear, very severe myofascial pain syndrome, cervical facet joint pain, carpal tunnel disease, etc.)
* Who were not able to follow the instructions of the therapist were excluded from the study.

Primary outcomes:
measure: Assessment of Pain Severity
timeFrame: February 2024
measure: Assessment of Neck Disability
timeFrame: February 2024
measure: Assessment of Motor Imagery Ability
timeFrame: February 2024
Secondary outcomes:
measure: Assessment of Grip Strength
timeFrame: February 2024
measure: Assessment of Muscular Endurance-Flexor
timeFrame: February 2024
measure: Assessment of Muscular Endurance-Extensor
timeFrame: February 2024
measure: Assessment of Muscular Endurance-Deep Flexor
timeFrame: February 2024
measure: Assessment of Neck Awareness
timeFrame: February 2024
measure: Assessment of Upper Extremity Functionality
timeFrame: February 2024
measure: Assessment of Depression Level
timeFrame: February 2024
Other outcomes:
Locations:
city: Yozgat
country: Turkey
facility: Sarıkaya Physical Therapy and Rehabilitation High School
state: Sarıkaya
Study officials:
affiliation: Yozgat Bozok University
name: Tuğba Dere, MSc
role: PRINCIPAL_INVESTIGATOR
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citation: Javdaneh N, Molayei F, Kamranifraz N. Effect of adding motor imagery training to neck stabilization exercises on pain, disability and kinesiophobia in patients with chronic neck pain. Complement Ther Clin Pract. 2021 Feb;42:101263. doi: 10.1016/j.ctcp.2020.101263. Epub 2020 Nov 19.
citation: Lebon F, Guillot A, Collet C. Increased muscle activation following motor imagery during the rehabilitation of the anterior cruciate ligament. Appl Psychophysiol Biofeedback. 2012 Mar;37(1):45-51. doi: 10.1007/s10484-011-9175-9.