Action Observation and Motor Imagery Training in Cervical Disc Herniation
Trial statusNot yet recruiting
Trial phaseNot applicable
Trial typeInterventional
Biological sexAll
Age18-65
Sponsorİrem Çetinkaya
About this trial
Cervical disc herniation is a common degenerative spinal disorder associated with chronic neck pain, impaired cervical function, reduced motor control, and decreased quality of life. Although conventional physiotherapy is widely used, innovative rehabilitation strategies that enhance motor learning may improve treatment outcomes. This randomized controlled trial aims to investigate the clinical effectiveness of Action Observation (AO) and Motor Imagery (MI) training as an adjunct to conventional physiotherapy in individuals with cervical disc herniation and chronic neck pain.
Thirty-six participants diagnosed with cervical disc herniation will be randomly assigned to one of two groups. The control group will receive conventional physiotherapy combined with sham observation consisting of neutral nature videos, while the experimental group will receive conventional physiotherapy plus AO and MI training. The intervention period will last six weeks. Clinical outcomes will be assessed before and after the intervention. Primary and secondary outcome measures will include pain intensity, pressure pain threshold, neck disability, kinesiophobia, cervical motor control and endurance, and cervical proprioception using validated assessment tools.
The findings of this study are expected to provide evidence regarding the effectiveness of AO and MI training as complementary rehabilitation approaches for individuals with cervical disc herniation and to support the integration of motor learning-based interventions into clinical physiotherapy practice.
Eligibility criteria
This trial does not accept healthy volunteersQualifiers
None
Disqualifiers
None
Trial design
Design model
Parallel
Treatments tested in this trial
Conventional Physiotherapy
Other interventionParticipants in both study groups will receive an individualized conventional physiotherapy program three times per week for six weeks. The program will include electrotherapy (conventional transcutaneous electrical nerve stimulation or vacuum interferential current applied on alternating sessions), superficial heat therapy, soft tissue mobilization, and a supervised therapeutic exercise program. The exercise program will consist of deep cervical flexor activation exercises, cervical range-of-motion exercises, scapular stabilization exercises, postural correction exercises, and stretching exercises targeting the upper trapezius, levator scapulae, and pectoral muscles. All treatment sessions will be delivered individually by the same physiotherapist, and exercise intensity will be adjusted according to each participant's tolerance and clinical status.
Action Observation and Motor Imagery Training
Other interventionParticipants in the experimental group will receive approximately 20 minutes of Action Observation (AO) and Motor Imagery (MI) training in addition to conventional physiotherapy during each treatment session, three times per week for six weeks. During the AO component, participants will observe standardized videos demonstrating correct execution of cervical and scapular movements, including cervical flexion, extension, lateral flexion, rotation, and scapular retraction. Immediately afterward, participants will perform MI under physiotherapist supervision by mentally rehearsing the same movements using both visual imagery (imagining observing themselves performing the movement) and kinesthetic imagery (imagining the sensory experience of performing the movement). All sessions will be delivered individually following a standardized intervention protocol.
Sham Observation
Other interventionParticipants in the control group will receive approximately 20 minutes of sham observation in addition to conventional physiotherapy during each treatment session, three times per week for six weeks. Instead of Action Observation and Motor Imagery training, participants will watch neutral nature videos without any human movement or motor-related content. The sham intervention is designed to match the experimental intervention in duration, therapist supervision, and attention while avoiding activation of motor learning processes.
Treatment groups
36 Participants
are divided into 2 treatment groupsGroup A: Experimental GroupExperimental treatment 2 interventions
Group B: Control GroupSham comparator 2 interventions
Trial outcomes
Primary outcomes
1
Neck Disability Index
Neck-related disability will be assessed using the Neck Disability Index (NDI). The NDI consists of 10 items addressing pain intensity, personal care, lifting, reading, headaches, concentration, work, driving, sleeping, and recreation. Each item is scored from 0 to 5, resulting in a total score ranging from 0 to 50. Higher scores indicate greater neck-related disability.
Time frame
Baseline and immediately after the 6-week intervention2
Craniocervical Flexion Test
Deep cervical flexor motor control and endurance will be assessed using the Craniocervical Flexion Test with a pressure biofeedback unit. Participants will perform progressive craniocervical flexion at five pressure levels (22-30 mmHg) from a baseline pressure of 20 mmHg. The highest pressure level successfully achieved and maintained for 10 seconds without compensatory movement will be recorded as the motor control performance. The participant's ability to sustain the target pressure level throughout the test will also be used to evaluate deep cervical flexor muscle endurance. Higher performance reflects better motor control and endurance.
Time frame
Baseline and immediately after the 6-week interventionSecondary outcomes
1
Visual Analog Scale for Pain
Neck pain intensity will be assessed using a 10-cm Visual Analog Scale. Participants will mark their perceived pain intensity on a horizontal line ranging from 0, indicating no pain, to 10, indicating the worst imaginable pain. Higher scores indicate greater pain intensity.
Time frame
Baseline and immediately after the 6-week intervention2
Pressure Pain Threshold Measured With a Digital Algometer
Pressure pain threshold will be assessed using a digital pressure algometer. Measurements will be performed bilaterally at the level of the C5 vertebra and at the midpoint of the upper trapezius muscle. Pressure will be gradually increased until the participant first reports pain. Three measurements will be obtained from each assessment site, and the mean value will be recorded. Higher values indicate a higher pressure pain threshold and lower mechanical pain sensitivity.
Time frame
Baseline and immediately after the 6-week intervention3
Tampa Scale for Kinesiophobia-11
Fear of movement will be assessed using the 11-item Tampa Scale for Kinesiophobia (TSK-11). Each item is scored on a 4-point Likert scale, and the total score ranges from 11 to 44. Higher scores indicate greater pain-related fear of movement.
Time frame
Baseline and immediately after the 6-week intervention4
Cervical Joint Position Error
Cervical proprioception will be assessed using the Laser Pointer Assisted Active Repositioning Test. Participants will perform a cervical movement and then attempt to return their head to the initial neutral position. The difference between the initial and repositioned head positions will be recorded as the absolute joint position error in degrees. Lower error values indicate better cervical proprioceptive accuracy.
Time frame
Baseline and immediately after the 6-week interventionLocations
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Source ClinicalTrials.gov
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