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Meta-Analysis
. 2020 Sep 24;9(9):CD013019.
doi: 10.1002/14651858.CD013019.pub2.

Motor imagery for gait rehabilitation after stroke

Stephano Silva  1 , Lorenna Rdm Borges  1 , Lorenna Santiago  1 , Larissa Lucena  1 , Ana R Lindquist  1 , Tatiana Ribeiro  1
Affiliations
Meta-Analysis

Motor imagery for gait rehabilitation after stroke

Stephano Silva et al. Cochrane Database Syst Rev. .

Abstract

Background: Motor imagery (MI) is defined as a mentally rehearsed task in which movement is imagined but is not performed. The approach includes repetitive imagined body movements or rehearsing imagined acts to improve motor performance.

Objectives: To assess the treatment effects of MI for enhancing ability to walk among people following stroke.

Search methods: We searched the Cochrane Stroke Group registry, CENTRAL, MEDLINE, Embase and seven other databases. We also searched trial registries and reference lists. The last searches were conducted on 24 February 2020.

Selection criteria: Randomized controlled trials (RCTs) using MI alone or associated with action observation or physical practice to improve gait in individuals after stroke. The critical outcome was the ability to walk, assessed using either a continuous variable (walking speed) or a dichotomous variable (dependence on personal assistance). Important outcomes included walking endurance, motor function, functional mobility, and adverse events.

Data collection and analysis: Two review authors independently selected the trials according to pre-defined inclusion criteria, extracted the data, assessed the risk of bias, and applied the GRADE approach to evaluate the certainty of the evidence. The review authors contacted the study authors for clarification and missing data.

Main results: We included 21 studies, involving a total of 762 participants. Participants were in the acute, subacute, or chronic stages of stroke, and had a mean age ranging from 50 to 78 years. All participants presented at least some gait deficit. All studies compared MI training versus other therapies. Most of the included studies used MI associated with physical practice in the experimental groups. The treatment time for the experimental groups ranged from two to eight weeks. There was a high risk of bias for at least one assessed domain in 20 of the 21 included studies. Regarding our critical outcome, there was very low-certainty evidence that MI was more beneficial for improving gait (walking speed) compared to other therapies at the end of the treatment (pooled standardized mean difference (SMD) 0.44; 95% confidence interval (CI) 0.06 to 0.81; P = 0.02; six studies; 191 participants; I² = 38%). We did not include the outcome of dependence on personal assistance in the meta-analysis, because only one study provided information regarding the number of participants that became dependent or independent after interventions. For our important outcomes, there was very low-certainty evidence that MI was no more beneficial than other interventions for improving motor function (pooled mean difference (MD) 2.24, 95% CI -1.20 to 5.69; P = 0.20; three studies; 130 participants; I² = 87%) and functional mobility at the end of the treatment (pooled SMD 0.55, 95% CI -0.45 to 1.56; P = 0.09; four studies; 116 participants; I² = 64.2%). No adverse events were observed in those studies that reported this outcome (seven studies). We were unable to pool data regarding walking endurance and all other outcomes at follow-up.

Authors' conclusions: We found very low-certainty evidence regarding the short-term benefits of MI on walking speed in individuals who have had a stroke, compared to other therapies. Evidence was insufficient to estimate the effect of MI on the dependence on personal assistance and walking endurance. Compared with other therapies, the evidence indicates that MI does not improve motor function and functional mobility after stroke (very low-certainty evidence). Evidence was also insufficient to estimate the effect of MI on gait, motor function, and functional mobility after stroke compared to placebo or no intervention. Motor Imagery and other therapies used for gait rehabilitation after stroke do not appear to cause significant adverse events.

PubMed Disclaimer

Conflict of interest statement

Stephano Silva: none known.

Lorenna RDM Borges: none known.

Lorenna Santiago: none known.

Larissa Lucena: none known.

Ana Raquel Rodrigues Lindquist: none known.

Tatiana Ribeiro: none known.

Figures

1
1
4747Study flow diagram.
2
2
Figure 2: Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
3
3
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
1.1
1.1. Analysis
Comparison 1: Motor Imagery therapy versus other therapies (control): effect on ability to walk, Outcome 1: Walking speed
1.2
1.2. Analysis
Comparison 1: Motor Imagery therapy versus other therapies (control): effect on ability to walk, Outcome 2: Subgroup analysis: post‐stroke time
1.3
1.3. Analysis
Comparison 1: Motor Imagery therapy versus other therapies (control): effect on ability to walk, Outcome 3: Subgroup analysis: treatment dose
1.4
1.4. Analysis
Comparison 1: Motor Imagery therapy versus other therapies (control): effect on ability to walk, Outcome 4: Subgroup analysis: type of treatment
1.5
1.5. Analysis
Comparison 1: Motor Imagery therapy versus other therapies (control): effect on ability to walk, Outcome 5: Subgroup analysis: walking dependence
1.6
1.6. Analysis
Comparison 1: Motor Imagery therapy versus other therapies (control): effect on ability to walk, Outcome 6: Subgroup analysis: forms of application of MI
2.1
2.1. Analysis
Comparison 2: Motor imagery versus other therapies (control): effect on motor function, Outcome 1: Motor function
2.2
2.2. Analysis
Comparison 2: Motor imagery versus other therapies (control): effect on motor function, Outcome 2: Subgroup analysis: post‐stroke time
2.3
2.3. Analysis
Comparison 2: Motor imagery versus other therapies (control): effect on motor function, Outcome 3: Subgroup analysis ‐ treatment dose
2.4
2.4. Analysis
Comparison 2: Motor imagery versus other therapies (control): effect on motor function, Outcome 4: Subgroup analysis: forms of application of MI
3.1
3.1. Analysis
Comparison 3: Motor imagery versus other therapies (control): effect on functional mobility, Outcome 1: Functional mobility
3.2
3.2. Analysis
Comparison 3: Motor imagery versus other therapies (control): effect on functional mobility, Outcome 2: Subgroup analysis: treatment dose
3.3
3.3. Analysis
Comparison 3: Motor imagery versus other therapies (control): effect on functional mobility, Outcome 3: Functional mobility ‐ sensitivity analysis: studies without high risk of bias
3.4
3.4. Analysis
Comparison 3: Motor imagery versus other therapies (control): effect on functional mobility, Outcome 4: Functional mobility ‐ sensitivity analysis: without peripheral studies
3.5
3.5. Analysis
Comparison 3: Motor imagery versus other therapies (control): effect on functional mobility, Outcome 5: Subgroup analysis: forms of application of MI
See this image and copyright information in PMC

Update of

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References to studies awaiting assessment

References to ongoing studies

ChiCTR1800019581 {published data only}
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NCT01993563 {published data only}
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NCT03436810 {published data only}
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