Graded Motor Imagery Training in Shoulder Impingement Syndrome

The Effectiveness of Graded Motor Imagery Training in Patients With Shoulder Impingement Syndrome

The aim of this study is to investigate the effects of Graded Motor Imagery (GMI) training on pain, functionality, disability and daily living activities in patients diagnosed with Shoulder Impingement Syndrome.

In this study 42 voluntary patients with Shoulder Impingement Syndrome, aged between 25-65 years will be randomly divided into two groups; group1: "GMI + Conventional Physiotherapy", group 2: "Conventional Physiotherapy".

All participants will receive treatment with a physiotherapist three times a week for six-weeks (18 sessions). At the end of the 6th week, it will be followed regularly with a six-week home exercise program. It will be evaluated by a physiotherapist three times in total (before treatment, at the end of six-weeks of treatment and after six-weeks of follow-up). In addition, all patients will undergo an interim evaluation in terms of primary outcome measures (VAS and DASH score) at week three. The shoulder pain on activity, at rest and at night will be assessed with Visual Analog Scale (VAS), Joint Range of Motion (ROM) will be measured with digital goniometer, strength of shoulder flexor, abductor, external and internal rotator muscles will be assessed with digital dynamometer, functional status will be evaluated with Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, functional status of the hand will be evaluated with Jebsen-Taylor Hand Function Test (JTHFT), lateralization evaluation will be assessed with the Recognise™ application (Shoulder and Hand), and motor imagery will be evaluated with the Kinesthetic and Visual Imagery Questionnair (KVIQ). Patient satisfaction will be evaluated by the Global Rating of Change scale.

Inclusion Criteria:

• Aged between 25-65 years old,
• Having been diagnosed with Shoulder Impingement Syndrome by physical examination and MRI as a result of shoulder pain lasting at least 3 months,
• Presence of a painful arc between 60° and 120° in shoulder flexion / abduction (elevation) movements,
• The Standardized Mini Mental Test result must be at least 24 points,
• Not having seen imagery practice before,

Exclusion Criteria:

• Having severe mental and communication problems,
• Having undergone surgical treatment on the same upper extremity,
• Presence of acute trauma, peripheral nervous system lesion, fracture or complete tendon rupture in the affected shoulder,
• Presence of other pathologies such as adhesive capsulitis of the shoulder joint complex and glenohumeral instability,
• Presence of radiotherapy history on the same side as the affected shoulder,
• Presence of congenital deformity,
• Symptomatic cervical spine pathology,
• Presence of other neurological or rheumatological disorders affecting upper motor function,
• Having any chronic disease that would prevent participation in the treatment program,
• Having attended a physiotherapy program within the last month.