Motor imagery as an intervention to improve activities of daily living post-stroke: A systematic review of randomized controlled trials.

Only 13 small trials were included, with individual sample sizes ranging from 20 to 121 participants, so the total evidence base is thin. The studies used different outcome measures (Barthel Index, Modified Barthel Index, FIM, and an original task-observation scale), different imagined actions, different doses, and different stages of recovery, making it hard to identify what exactly makes a programme work. Two of the four audio-guided studies did not give the control group the same extra time for listening, so part of the measured benefit may be due to additional therapeutic contact rather than the imagery itself. The two positive therapist-directed studies used a non-validated 7-point Likert scale to rate task performance, and their participants were on average around 2 weeks post-stroke, earlier than the other therapist-directed studies. All 13 studies failed to blind participants or therapists, and 10 of 13 did not report an intention-to-treat analysis. The search was restricted to English-language publications, so relevant studies in other languages may have been missed. Two included studies could not be assigned to a delivery-mode category because they did not describe how the imagery was instructed, so they were excluded from the category-level interpretation.

The authors declared no conflicts of interest and received no financial support for the research, authorship, or publication.

Do not read the audio-guided results as proof that motor imagery alone improves daily living independence. In every one of those four studies, the imagery was added on top of another treatment such as occupational therapy, transcranial magnetic stimulation, or constraint-induced therapy. Two of the four did not give the control group the same extra time for listening. The visual-guided category was null in all three studies, and the therapist-directed category was split.