Prescription of Graded Motor Imagery for People With Chronic Pain: A Scoping Review

Abstract

Background: This scoping review investigates how graded motor imagery (GMI) and its individual components (left/right judgments, imagined movements and mirror therapy) are applied in clinical trials for people with chronic pain conditions. Understanding how GMI is prescribed is essential to guide its standardization and optimization for clinical practice.

Methods: We searched the Cochrane Database of controlled trials, PubMed, CINAHL, Embase and PsycINFO from inception to May 2024 for randomized controlled trials published in English that examined the effects of GMI or its components either alone or with usual care. Eligible trials included participants with chronic pain conditions (e.g., phantom limb pain, complex regional pain syndrome, chronic musculoskeletal pain) and reported pain intensity as an outcome. Clinical aspects of each intervention were extracted according to the Template for Intervention Description and Replication (TIDieR).

Results: Results were narratively summarized. Thirty-two studies were included, encompassing 38 intervention arms: 8 GMI arms, 1 left/right judgment discrimination arm, 13 imagined movements arms and 16 mirror therapy arms. All GMI intervention arms followed the original protocol established by Moseley in 2004. In contrast, trials applying one or two components of GMI showed greater variability in intervention duration, session length and frequency and instructions to participants.

Conclusion: These findings suggest that GMI protocols are consistent across trials; however, further testing of the standard GMI protocol is needed due to the small sample sizes in published trials. Additionally, there is scope to test adapted versions of GMI, considering the varied approaches seen in trials applying individual GMI components for chronic pain management.

Significance statement: This scoping review systematically maps how graded motor imagery and its individual components have been prescribed in clinical trials for chronic pain using a structured reporting framework. It shows that while full graded motor imagery interventions largely follow the original protocol, trials of individual components display substantial variation in dose, sequencing and delivery, often with incomplete reporting. These findings clarify sources of heterogeneity in the literature and support more consistent intervention reporting and design to strengthen future synthesis and clinical translation.