Graded Motor Imagery and Task-Oriented Exercise in Shoulder Impingement
Trial statusRecruiting
Trial phaseNot applicable
Trial typeInterventional
Biological sexAll
Age25-65
SponsorFenerbahce University
About this trial
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.
Eligibility criteria
This trial does not accept healthy volunteersQualifiers
None
Disqualifiers
None
Trial design
Design model
Parallel
Treatments tested in this trial
Electrotherapy + Conventional Exercise Group
Other interventionAll 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 during the first week, followed by progressive TheraBand® resistance from week two. Posterior, anterior, and inferior capsule stretching, pectoral stretching, and shoulder-scapular mobilization will be performed under physiotherapist supervision. Exercises will be applied twice weekly for 6 weeks, with 3 sets of 10 repetitions.
The graded motor imagery program
Other interventionThe 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°) and mentally rehearsing the movements for 3 sets of 10 repetitions. Mirror therapy requires participants to view the reflection of their unaffected shoulder and perform the imagined movements. Mirror therapy will also be applied twice weekly for 2 weeks, with 3 sets of 10 repetitions
The task-oriented exercise program
Other interventionThe 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 overhead light bulb, washing hair, combing hair, putting on and taking off a pullover shirt, and donning a jacket or cardigan. Weeks 4-6 include placing a 0.5-kg weight on an overhead shelf (front and side), washing or scratching the upper and lower back, and placing a wallet in the back pocket.
Treatment groups
66 Participants
are divided into 3 treatment groupsGroup A: Conventional PhysiotherapyActive comparator 1 intervention
Group B: Graded Motor ImageryActive comparator 2 interventions
Group C: Task-Oriented Exercise TrainingActive comparator 2 interventions
Trial outcomes
Primary outcomes
1
Assessment of Muscle Strength
Muscle strength will be assessed using the Lafayette Manual Muscle Tester (MMT). Shoulder flexion, extension, abduction, internal rotation, and external rotation muscle strengths will be evaluated. Three consecutive measurements will be taken for each movement, and the mean value will be recorded.
Time frame
At baseline and at the end of the 6-week intervention period2
Assessment of Pain Intensity
Pain intensity will be assessed using a 10 cm Visual Analog Scale (VAS), ranging from '0' (no pain) to '10' (unbearable pain). Participants will rate their pain levels before and after the intervention in three conditions: at rest, during activity, and at night
Time frame
At baseline and at the end of the 6-week intervention period3
Assessment of Pain Threshold
The pain threshold will be assessed using an algometer, a device that measures the pressure at which pain is first perceived. During the measurement, the participant must remain in a relaxed position, and the tip of the algometer must be applied at a 90-degree angle to the tissue. As pressure gradually increases, the participant will be instructed to indicate the moment when pain or discomfort is first felt. This point will be recorded as the pain threshold . In this study, the Commander Echo Algometer will be used to assess pain thresholds. Measurements will be taken from the deltoid muscle, supraspinatus muscle, infraspinatus muscle, and the participant's self-reported most painful area. Each measurement will be repeated three times, and the mean value will be recorded.
Time frame
At baseline and at the end of the 6-week intervention period4
Assessment of Shoulder Range of Motion
Shoulder range of motion will be assessed using a Baseline goniometer (RMS UK Ltd., Nailsea). The joint movements to be evaluated include flexion, extension, abduction, internal rotation, and external rotation, and the results will be recorded in degrees. For each movement, three consecutive measurements will be taken, and the mean value will be used for analysis
Time frame
At baseline and at the end of the 6-week intervention periodSecondary outcomes
1
Assessment of Laterality Recognition
Shoulder laterality performance will be assessed using the 'Recognise™' application developed by the Neuro Orthopaedic Institute. The 'Recognise™ Shoulder' section of the app, specifically the 'Vanilla' mode, will be used. A total of 20 shoulder images will be presented for 5 seconds each. Participants will be asked to identify as quickly and accurately as possible whether the displayed image represents a right or left shoulder by pressing the corresponding button on the screen. The percentage of correct responses and reaction time will be recorded as outcome measures.
Time frame
At baseline and at the end of the 6-week intervention period2
Assessment of Movement Imagery Ability
Movement imagery ability will be assessed using the Movement Imagery Questionnaire-3 (MIQ-3). The questionnaire consists of 12 items. Participants are asked to imagine four different movements using internal visual imagery, external visual imagery, and kinesthetic imagery. They rate the clarity or ease of imagining each movement on a 7-point ordinal scale (1 = very hard to feel/see, 7 = very easy to feel/see)
Time frame
At baseline and at the end of the 6-week intervention period3
Assessment of Kinesiophobia
Kinesiophobia will be assessed using the Tampa Scale for Kinesiophobia (TSK), developed by Miller, Kori, and Todd. The scale consists of 17 items evaluating fear of injury, reinjury, fear-avoidance beliefs, and activity-related concerns. Each item is scored on a 4-point Likert scale ranging from 1 (strongly disagree) to 4 (strongly agree). Higher scores indicate a higher level of kinesiophobia.
Time frame
At baseline and at the end of the 6-week intervention period4
Assessment of Patient Satisfaction
Patient satisfaction with treatment will be assessed using the Global Rating of Change (GRC) Scale. This scale is widely used in clinical research, particularly in musculoskeletal conditions. It is designed to measure a patient's perceived improvement or deterioration over time, either to determine the effectiveness of an intervention or to track clinical progress. The version used in this study consists of 5 levels and is scored between -2 and +2.
Time frame
It will be assessed at the end of the 6-week treatment period.Sponsors and contacts
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Source ClinicalTrials.gov