Pain Relief by Movement Representation Strategies: An Umbrella and Mapping Review with Meta-Meta-Analysis of Motor Imagery, Action Observation and Mirror Therapy.

Abstract

OBJECTIVE\nTo develop a mapping and umbrella review with a meta-meta-analysis (MMA) to critically evaluate the current evidence of motor imagery (MI), action observation and mirror therapy (MT) on pain intensity.\n\n\nMETHODS\nThe study involved a systematic search of PubMed, PEDro, Scielo, EBSCO and Google Scholar, RESULTS: Ten systematic reviews were included in the qualitative synthesis, 70% of which showed high methodological quality. Three reviews found significant reduction in chronic musculoskeletal pain as the result of applying movement representation methods (MRM) plus usual-care (UC), with a large clinical effect (standardised mean difference [SMD] of -1.47; 95% CI -2.05 to -0.88; heterogeneity Q=1.66; p=0.44; I2 =0%). However, two reviews showed no statistically significant reduction in acute and postsurgical pain as a result of applying MI plus UC. Four reviews showed no significant reduction in phantom limb pain (PLP) as a result of applying MT plus UC interventions. In four reviews, the MMA showed significant reduction in complex regional pain syndrome (CRPS) as a result of applying MT plus UC, with a large clinical effect (SMD -1.27; 95% CI -1.87 to -0.67; heterogeneity Q=3.95; p=0.27; I2 =24%). In 2 reviews, the MMA showed no significant differences in poststroke pain as a result of applying MT plus UC.\n\n\nCONCLUSION\nResults show that MRM could be effective for chronic musculoskeletal pain, with low to moderate-quality evidence. The results also show a reduction in pain intensity through MT interventions in patients with CRPS, although these results were not found in patients with PLP or poststroke pain.