Graded Motor Imagery and Task-Oriented Exercise in Shoulder Impingement

Official title

Effectiveness of Graded Motor Imagery and Task-Oriented Exercise Training in Shoulder Impingement Syndrome

Overview

This study aims to compare the effects of graded motor imagery and task-oriented exercise training in individuals with shoulder impingement syndrome. A total of 66 participants aged 25-65 years will be randomly assigned to one of three groups: conventional physiotherapy, graded motor imagery, or task-oriented exercise training. All groups will receive standardized electrotherapy, while the intervention groups will additionally complete 6-week graded motor imagery or task-oriented exercise programs. Primary outcomes include pain intensity, shoulder range of motion, muscle strength, proprioception, functional status, kinesiophobia, laterality recognition, movement imagery ability, and patient satisfaction. Assessments will be conducted before and after the intervention by the same physiotherapist. The study aims to determine whether motor imagery-based or task-oriented rehabilitation provides additional benefits compared with conventional physiotherapy in individuals with shoulder impingement syndrome.

Detailed description

This study investigates the effects of graded motor imagery (GMI) and task-oriented exercise training on individuals diagnosed with shoulder impingement syndrome. Shoulder impingement is a common musculoskeletal problem that leads to pain, restricted mobility, reduced muscle strength, proprioceptive deficits, and functional limitations. Conventional physiotherapy approaches may not always be sufficient to address the complex sensorimotor deficits associated with this condition. Therefore, this study aims to evaluate whether GMI or task-oriented exercise programs can provide additional therapeutic benefits beyond standard physiotherapy.

A total of 66 participants, aged 25 to 65 years, who meet the diagnostic criteria for shoulder impingement syndrome, will be included. Participants will be randomly assigned to one of three groups:

Conventional physiotherapy (control group)

Graded motor imagery training

Task-oriented exercise training

All groups will receive standardized electrotherapy interventions as part of routine physiotherapy. In addition to this standard treatment, the two intervention groups will engage in a 6-week structured program based on either GMI or task-oriented exercises, depending on group allocation.

Outcome measures will include pain intensity, shoulder range of motion, muscle strength, proprioception, functional level, kinesiophobia, laterality recognition, movement imagery ability, and patient satisfaction. All assessments will be conducted before and after the 6-week intervention by the same physiotherapist to ensure consistency.

The purpose of this study is to determine whether GMI or task-oriented exercise training offers superior improvements in pain, motor performance, proprioceptive control, and functional outcomes when compared with conventional physiotherapy alone. The findings are expected to contribute to evidence-based rehabilitation practices and provide clinicians with additional strategies for managing shoulder impingement syndrome.

Interventions

• Other Electrotherapy + Conventional Exercise Group
  All participants will receive an electrotherapy program consisting of TENS (100 Hz, 20 minutes), ultrasound (1.5 W/cm², 6 minutes), and cold pack application (15 minutes), delivered 5 days per week for 6 weeks. The conventional exercise program includes wand exercises (flexion, abduction, extension, external/internal rotation), Codman exercises in multiple directions, and finger ladder exercises with a 5-second hold at end range. Strengthening exercises will be performed without resistance durin
• Other The graded motor imagery program
  The graded motor imagery program consists of 2 weeks of laterality training, 2 weeks of motor imagery, and 2 weeks of mirror therapy. Laterality training will be performed using the Recognise™ Shoulder app (NOI), where participants identify whether presented images show a right or left shoulder. Training will be conducted twice weekly for 2 weeks. Motor imagery includes viewing shoulder movement images (flexion 180°, abduction 180°, external rotation 90°, internal rotation 90°, extension 45°) an
• Other The task-oriented exercise program
  The task-oriented exercise program is based on daily activities related to DASH and SPADI items, focusing on functional shoulder movements including flexion, abduction, extension, and rotation. Exercises will be performed twice weekly for 6 weeks, 3 sets of 10 repetitions. Weeks 0-2 include placing an object on a front shelf, placing an object on a side shelf, placing the hand on the back, touching the neck, washing a plate, and wiping a wall within pain limits. Weeks 2-4 include changing an ove

Primary outcome measures

• Assessment of Muscle Strength [Time frame: At baseline and at the end of the 6-week intervention period]
• Assessment of Pain Intensity [Time frame: At baseline and at the end of the 6-week intervention period]
• Assessment of Pain Threshold [Time frame: At baseline and at the end of the 6-week intervention period]
• Assessment of Shoulder Range of Motion [Time frame: At baseline and at the end of the 6-week intervention period]
• Assessment of Active Joint Position Sense [Time frame: At baseline and at the end of the 6-week intervention period]
• Assessment of Upper Extremity Function [Time frame: At baseline and at the end of the 6-week intervention period]

Secondary outcome measures (4)

• Assessment of Laterality Recognition [Time frame: At baseline and at the end of the 6-week intervention period]
• Assessment of Movement Imagery Ability [Time frame: At baseline and at the end of the 6-week intervention period]
• Assessment of Kinesiophobia [Time frame: At baseline and at the end of the 6-week intervention period]
• Assessment of Patient Satisfaction [Time frame: It will be assessed at the end of the 6-week treatment period.]

Eligibility criteria

Inclusion Criteria:Adults aged 25-65 years

Diagnosed with Stage I or Stage II shoulder impingement syndrome by an Orthopedics or Physical Medicine and Rehabilitation physician

Positive Neer and Hawkins tests

Unilateral shoulder pain for at least 3 months

No participation in any physiotherapy program for shoulder problems within the last year

Ability to cooperate and follow instructions

A score of 24 or above on the Standardized Mini-Mental Test -

Exclusion criteria

History of previous shoulder surgery

Local corticosteroid injection within the last three months

Presence of uncontrolled neurological, cardiac, or systemic diseases that may interfere with function

Cognitive impairments that may affect proper understanding or execution of the motor imagery program

A score below 24 on the Standardized Mini-Mental Test

\-

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: No

Study design

Allocation

Randomized

Model

Parallel assignment

Masking

Open label

Primary purpose

Treatment

Study locations

Turkey (Türkiye) · 1 center

• Istanbul Medipol University, Institute of Health Sciences — Istanbul

Identifiers

NCT: NCT07290660 · FBU

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗