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Breckenridge J1,2, Ginn K1, Wallwork S3, McAuley J4,5
1University of Sydney, Sydney, Australia, 2Clinical Research Institute, Westmead, Australia, 3University of Canberra, Canberra, Australia, 4Neuroscience Research Australia (NeuRA), Sydney, Australia, 5University of New South Wales, Sydney, Australia
Background: Motor imagery performance as measured by the left/right judgement task (LRJT) is altered in the presence of chronic pain. Speed(RT) and accuracy(Acc) on the LRJT are reduced implying motor imagery processes are impaired and body schema disrupted. What is not known is whether pain intensity is related to LRJT performance.
Purpose: Conduct a comprehensive systematic review and meta-analysis of the literature to answer the question:Does pain intensity influence motor imagery performance?
Methods: Eight databases were searched using key terms for “left/right judgement” and “pain”. Studies using the LRJT applied to an adult chronic musculoskeletal pain population were included. Primary outcome measures were correlations between current(CurrP) and average(AvP) pain and LRJT performance measures; RT and Acc. Correlation data were subgrouped for analysis. Mean effect sizes were calculated. Heterogeneity was assessed, peripheral and axial subgroups examined. Quality of included studies was assessed.
Results: Searches resulted in 7,618 citations. Eighteen studiesmet inclusion criteria.
Findings: A small significant positive association between peripheral CurrP and RT, [0.209 (95%CI 0.100 to 0.314), p 0.001]; No significant effect of axial CurrP on RT (p=0.074).
There was a small significant positive effect between peripheral CurrP and Acc [0.124 (95%CI 0.001 to 0.243), p=0.049]; No significant effect of axial CurrP on Acc for the task (p=0.149).
A moderate positive association [0.368 (95%CI 0.213 to 0.505), p 0.001] was found between peripheral AvP and RT; No significant effect of axial AvP on RT (p=0.862).
No significant correlation between Acc and peripheral AvP (p = 0.393); No significant effect (p=0.772) between Acc and axial AvP.
ROB: High risk of selection bias. Low risk of detection bias. Assessor blinding in a third of studies. Smaller sample sizes may introduce bias through chance alone.
Conclusion(s): Overall results reveal that pain intensity does influence motor imagery performance. People with higher levels of pain - current and average pain - were slower at resolving the LRJT than people with lower levels of pain, demonstrating that motor imagery central processing are altered with increasing effect as pain intensifies.
Positive relationships between pain intensity and LRJT response times appear driven by peripheral pain conditions and were not apparent in axial pain conditions.
There was no consistent relationship between pain intensity and accuracy on the LRJT.
Implications: This review provides further evidence of maladaptive neuroplastic change associated with chronic musculoskeletal pain. Central processes required for successful motor imagery are impaired as chronic pain intensifies, particularly in peripheral conditions.
Keywords: Left/right judgement, motor imagery, meta-analysis
Funding acknowledgements: The authors have no funding to acknowledge.
Purpose: Conduct a comprehensive systematic review and meta-analysis of the literature to answer the question:Does pain intensity influence motor imagery performance?
Methods: Eight databases were searched using key terms for “left/right judgement” and “pain”. Studies using the LRJT applied to an adult chronic musculoskeletal pain population were included. Primary outcome measures were correlations between current(CurrP) and average(AvP) pain and LRJT performance measures; RT and Acc. Correlation data were subgrouped for analysis. Mean effect sizes were calculated. Heterogeneity was assessed, peripheral and axial subgroups examined. Quality of included studies was assessed.
Results: Searches resulted in 7,618 citations. Eighteen studiesmet inclusion criteria.
Findings: A small significant positive association between peripheral CurrP and RT, [0.209 (95%CI 0.100 to 0.314), p 0.001]; No significant effect of axial CurrP on RT (p=0.074).
There was a small significant positive effect between peripheral CurrP and Acc [0.124 (95%CI 0.001 to 0.243), p=0.049]; No significant effect of axial CurrP on Acc for the task (p=0.149).
A moderate positive association [0.368 (95%CI 0.213 to 0.505), p 0.001] was found between peripheral AvP and RT; No significant effect of axial AvP on RT (p=0.862).
No significant correlation between Acc and peripheral AvP (p = 0.393); No significant effect (p=0.772) between Acc and axial AvP.
ROB: High risk of selection bias. Low risk of detection bias. Assessor blinding in a third of studies. Smaller sample sizes may introduce bias through chance alone.
Conclusion(s): Overall results reveal that pain intensity does influence motor imagery performance. People with higher levels of pain - current and average pain - were slower at resolving the LRJT than people with lower levels of pain, demonstrating that motor imagery central processing are altered with increasing effect as pain intensifies.
Positive relationships between pain intensity and LRJT response times appear driven by peripheral pain conditions and were not apparent in axial pain conditions.
There was no consistent relationship between pain intensity and accuracy on the LRJT.
Implications: This review provides further evidence of maladaptive neuroplastic change associated with chronic musculoskeletal pain. Central processes required for successful motor imagery are impaired as chronic pain intensifies, particularly in peripheral conditions.
Keywords: Left/right judgement, motor imagery, meta-analysis
Funding acknowledgements: The authors have no funding to acknowledge.
Topic: Musculoskeletal; Pain & pain management
Ethics approval required: No
Institution: University of Sydney
Ethics committee: n/a
Reason not required: This is a systematic review of non sensitive deidentified previously published data
All authors, affiliations and abstracts have been published as submitted.
