Diminished Kinesthetic and Visual Motor Imagery Ability in Adults With Chronic Low Back Pain.

BACKGROUND: Low back pain (LBP) is the most prevalent musculoskeletal problem among adults. It has been observed that patients with chronic pain have maladaptive neuroplastic changes and difficulty in imagination processes. OBJECTIVE: To assess the ability of patients with chronic LBP (CLBP) to generate kinesthetic and visual motor images and the time they spent on this mental task compared with asymptomatic participants. DESIGN: A prospective, cross-sectional study. SETTING: Primary health care center in Madrid, Spain. PARTICIPANTS: A total of 200 participants were classified into 2 groups: asymptomatic participants (n = 100) and patients with CLBP (n = 100). METHODS: After consenting to participate, all recruited participants received a sociodemographic questionnaire, a set of self-report measures and completed the Revised Movement Imagery Questionnaire. MAIN OUTCOMES MEASUREMENTS: Visual and Kinesthetic Motor Imagery Ability using the Revised Movement Imagery Questionnaire. A mental chronometry using a stopwatch and psychosocial variables using self-reported questionnaires. RESULTS: Our results indicated that patients with CLBP had difficulty generating kinesthetic and visual motor images and also took a longer time to imagine them. A regression analysis indicated that in the CLBP group, the predictor variable for fear of activity and coping symptom self-efficacy was visual motor imagery (explaining 16.2% of the variance); however, the predictor variable for LBP disability and pain management self-efficacy was kinesthetic motor imagery (explaining 17.8% of the variance). CONCLUSIONS: It appears that patients with CLBP have greater difficulty generating visual and kinesthetic motor images compared with asymptomatic participants, and they also need more time to perform these mental tasks. LEVEL OF EVIDENCE: II.

Multimodal physiotherapy treatment based on a biobehavioral approach for patients with chronic cervico-craniofacial pain: a prospective case series.

The purpose of this prospective case series was to observe and describe changes in patients with chronic cervico-craniofacial pain of muscular origin treated with multimodal physiotherapy based on a biobehavioral approach. Nine patients diagnosed with chronic myofascial temporomandibular disorder and neck pain were treated with 6 sessions over the course of 2 weeks including: (1) orthopedic manual physiotherapy (joint mobilizations, neurodynamic mobilization, and dynamic soft tissue mobilizations); (2) therapeutic exercises (motor control and muscular endurance exercises); and (3) patient education. The outcome measures of craniofacial (CF-PDI) and neck disability (NDI), kinesiophobia (TSK-11) and catastrophizing (PCS), and range of cervical and mandibular motion (ROM) and posture were collected at baseline, and at 2 and 14 weeks post-baseline. Compared to baseline, statistically significant (p < 0.01) and clinically meaningful improvements that surpassed the minimal detectable change were observed at 14 weeks in CF-PDI (mean change, 8.11 points; 95% confidence interval (CI): 2.55 to 13.69; d = 1.38), in NDI (mean change, 5 cm; 95% CI: 1.74-8.25; d = 0.98), and in the TSK-11 (mean change, 6.55 cm; 95% CI: 2.79-10.32; d = 1.44). Clinically meaningful improvements in self-reported disability, psychological factors, ROM, and craniocervical posture were observed following a multimodal physiotherapy treatment based on a biobehavioral approach.