Immediate Effects of Mirror Therapy in Patients With Shoulder Pain and Decreased Range of Motion.

OBJECTIVE: To determine the effects of a brief single component of the graded motor imagery (GMI) sequence (mirror therapy) on active range of motion (AROM), pain, fear avoidance, and pain catastrophization in patients with shoulder pain. DESIGN: Single-blind case series. SETTING: Three outpatient physical therapy clinics. PARTICIPANTS: Patients with shoulder pain and limited AROM (N=69). INTERVENTION: Patients moved their unaffected shoulder through comfortable AROM in front of a mirror so that it appeared that they were moving their affected shoulder. MAIN OUTCOME MEASURES: We measured pain, pain catastrophization, fear avoidance, and AROM in 69 consecutive patients with shoulder pain and limited AROM before and immediately after mirror therapy. RESULTS: There were significant differences in self-reported pain (P=.014), pain catastrophization (P<.001), and the Tampa Scale of Kinesiophobia (P=.012) immediately after mirror therapy; however, the means did not meet or exceed the minimal detectable change (MDC) for each outcome measure. There was a significant increase (mean, 14.5°) in affected shoulder flexion AROM immediately postmirror therapy (P<.001), which exceeded the MDC of 8°. CONCLUSIONS: A brief mirror therapy intervention can result in statistically significant improvements in pain, pain catastrophization, fear avoidance, and shoulder flexion AROM in patients presenting with shoulder pain with limited AROM. The immediate changes may allow a quicker transition to multimodal treatment, including manual therapy and exercise in these patients. Further studies, including randomized controlled trials, are needed to investigate these findings and determine longer-term effects.

An investigation of the associations between measures of mindfulness and pain catastrophizing.

OBJECTIVE: Mindfulness and pain catastrophizing are important constructs in pain research, and there are theoretical reasons for suspecting that measures of the 2 constructs should be related in predictable ways. The present study investigated the association of pain catastrophizing (Pain Catastrophizing Scale) with mindfulness (Five Facet Mindfulness Questionnaire). The Penn State Worry Questionnaire was included to control for confounding of worry; the influence of demographics was explored. METHODS: The participants were 214 undergraduates, who were administered questionnaires via the Internet. Analyses assessed relationships after correcting for attenuation. RESULTS: The mindfulness scales had intercorrelations with catastrophizing ranging from -0.23 to 0.13; the Non-Judging, Non-Reactivity, and Acting with Awareness mindfulness scales correlated significantly with catastrophizing. However, worry was better correlated (r=0.35) with catastrophizing, and the mindfulness scales were not significantly related to catastrophizing after controlling for worry. Mindfulness scales were significant predictors (P=0.018) of catastrophizing scores in a single-indicator latent variable analysis, and 1 mindfulness scale (Non-Reactivity) contributed uniquely (P=0.006) to prediction. None of the mindfulness scales significantly predicted catastrophizing scores when worry was controlled, but the path from worry to catastrophizing was significant (P=0.048). Sex differences in catastrophizing scores were explained by sex differences on the worry scale (P<0.001). DISCUSSION: These findings suggest that it is important to assess more general cognitive-emotional constructs, such as worry, when making inferences about the influence of mindfulness or changes in mindfulness upon catastrophic thinking in response to pain.