Implicit Motor Imagery for Chronic Pelvic Pain: A Cross-Sectional Case-Control Study

Do menstrual symptoms affect motor imagery skills in young women?

PURPOSE

To examine the relationship between menstrual symptoms and motor imagery skills in young women.

METHODS

A total of 117 women between the ages of 18-40 were included in the study. Visual Analog Scale (VAS) for the menstrual pain intensity, the Menstrual Symptom Questionnaire (MSQ) for the menstrual-related symptoms, and the Kinesthetic and Visual Imagery Questionnaire-20 (KVIQ-20) for the motor imagery were used. All measurements were conducted on the first or second day of the menstruation, depending on when the subject declared subjectively experiencing most symptoms.

RESULTS

The relationship between menstruation symptoms and visual imagery (VI) and kinesthetic imagery (KI) skills was examined. A weak negative correlation was found between MSQ_negative effects/somatic complaints and KVIQ-20_KI (p = .040, r = -.199). The relationship between menstrual pain intensity and KVIQ-20 items was examined. The strongest relationship was found between VAS and KVIQ-20_knee_VI and KVIQ-20_hip_VI (p = 003, r = -.288; p = 005, r = -.270; p = 004, respectively). A weak negative correlation was also found between VAS and KVIQ-20_VI_total and KVIQ-20_KI_total (p = 0.004, r = -.275; p = 0.19, r = -.227, respectively).

DISCUSSION

This is the first study to examine menstrual symptoms in women in detail and reveal their relationship with motor imagery skills. Menstrual symptoms, especially negative effects/somatic complaints seen during menstruation, negatively affect kinesthetic imagery ability. In addition; chronic menstrual pain has a negative effect on both kinesthetic and visual imagery abilities. Considering the impairments in motor imagery skills due to negative effects/somatic complaints during menstruation and chronic menstrual pain, adding motor imagery training to treatment programs aimed at improving women's health may have positive effects.

Response in Patients With Persistent Pelvic Pain to Motor Imagery Through Auditory or Visual Input-A Pilot Randomized Trial

Purpose: This study evaluates the response to a motor imagery intervention using visual or auditory inputs in patients with persistent pelvic pain. A secondary objective is to assess how patients' mental visualization capacity influences intervention outcomes. Methods: Forty patients diagnosed with persistent pelvic pain were enrolled in a randomized trial with six motor imagery sessions over 2 weeks. Patients were assigned to interventions delivered through images or audio recordings. Pain intensity, attention to pain, and the ability to mentally visualize and perceive movements were assessed. Results: Participants receiving auditory stimulus-based interventions showed a nonsignificant reduction in pain intensity (from 7.1 points [SD: 1.9] to 6.1 points [SD: 2.4]; p=0.091), while those in the visual input group experienced no change. Attention to pain improved in the visual group (from 30.2 points [SD: 6.2] to 27.6 points [SD: 6.8]; p=0.194), whereas it remained stable in the auditory group. Importantly, the participants' ability to mentally visualize and perceive movements did not significantly impact the outcomes. Conclusions: Auditory motor imagery appears to be a promising, less intrusive approach for managing persistent pelvic pain, with home-based interventions showing potential where access to conventional care is limited. This study highlights the importance of personalized motor imagery approaches, demonstrating superior efficacy for auditory interventions compared to visual ones. Limitations include a brief intervention period and recruitment challenges, yet motor imagery remains a viable therapeutic option. Trial Registration: ClinicalTrials.gov identifier: NCT06343649.

Online Graded Motor Imagery Is Effective in Women Diagnosed With Pelvic Pain: A Randomized Controlled Trial

OBJECTIVE

Effective therapeutic strategies are crucial for managing genito-pelvic pain/penetration disorder (GPPPD), a condition presenting challenges for both patients and health care providers. This study aims to assess the effectiveness of an online graded motor imagery (GMI) program in alleviating pain intensity and improving sexual function in women diagnosed with GPPPD.

METHODS

Eighty-seven women were randomly assigned to either an online GMI group or a control group. The online GMI protocol involved engaging participants in 2-week segments of left/right judgment exercises, mental simulation of movements, and gradual exposure therapy. After 6 weeks, we assessed pain intensity and sexual function. The control group gained access to the program upon study completion.

RESULTS

The online GMI group demonstrated a significant reduction in pain intensity, coupled with improvements in sexual function. Notably, participants with enhanced movement imagery abilities experienced greater improvements, while those with negative beliefs and thoughts regarding vaginal penetration showed lower sexual function scores.

CONCLUSION

An online GMI program is effective in alleviating the pain burden faced by women dealing with GPPPD.

IMPACT

Effectively addressing pelvic pain in patients remains a daunting challenge for physical therapists. Therefore, implementing efficient and easily accessible strategies is crucial. The incorporation of GMI intervention proves to be an effective approach for improving both pain and sexual functioning in women with GPPPD.

Effects of motor imagery and action observation on pelvic floor and related structures in healthy women: A randomized controlled trial

The main aim was to assess the effects of motor imagery (MI) and action observation (AO) plus physical exercise (PE) on pelvic floor and related structures. Forty-four healthy women were randomized into three groups: MI, AO, or sham observation (SO) group. The outcome measures included the pelvic floor muscles (PFM) condition (including basal tone and strength), lumbo-pelvic motor control, and pain sensitivity. All women performed six sessions at the rate of 3 s/week (for 2 weeks). An initial assessment was carried out (T0), another one 1-week after starting the study (T1), and a third one at the end (T2). Results showed significant PFM strength gains in MI and AO groups, but not in the SO group. Regarding lumbo-pelvic motor control, both MI and AO groups obtained statistically significant changes between pre- and post-intervention Additionally, only the AO group showed significant improvements already at 1-week of intervention. Finally, all groups showed improved pain sensitivity in the likely area of referred menstrual pain post-intervention, with only the MI group showing changes 1 week after starting the intervention. In conclusion, results showed that adding MI and AO to PE program leads to an improvement of sensorimotor function of PFM and related structures in general. Despite finding no statistically significant inter-group differences, some findings such as strength gains or the lumbo-pelvic motor control improvements were only found in MI and AO groups, and this should be considered clinically.

The Development and Evaluation of the Kinesthetic Motor Imagery of Pelvic Floor Muscle Contraction Questionnaire (KMI-PFQ) in Spanish Women

Practitioners have begun using motor imagery (MI) for preventing and treating some pelvic floor disorders. Due to requirements for imagining before performing a MI intervention and because there are few instruments available for assessing this specific ability in the pelvic floor musculature, we sought to develop and test a new MI questionnaire, the Kinesthetic Motor Imagery of Pelvic Floor Muscle Contraction Questionnaire (KMI-PFQ). We focused in this study on the development and analysis of the instrument's factorial structure and internal reliability in a participant sample of 162 healthy Spanish women (M age = 20.1, SD = 2.2 years). We developed and evaluated the KMI-PFQ's psychometric properties, finding it to have good internal consistency, with Cronbach's α = .838, ω coefficient = .839, and an intraclass correlation coefficient = .809, with two factors ("ability" and "mental effort") explaining 58.36% of response variance. The standard error of measurement was 3.58, and the minimal detectable change was 9.92. No floor or ceiling effects were identified. There was also good convergent validity as seen by statistically significant positive correlations between KMI-PFQ scores and the revised-Movement Image Questionnaire and Vividness of Visual Imagery Questionnaire. There were no statistically significant correlations between KMI-PFQ scores and the Orientation to Life Questionnaire. The KMI-PFQ is a valid and reliable instrument for measuring kinesthetic ability to feel/imagine pelvic floor muscle contractions in healthy Spanish women.

App-Mohedo®: A mobile app for the management of chronic pelvic pain. A design and development study

BACKGROUND

Chronic Pelvic Pain (CPP) has been described as a public health priority worldwide, and it is among the most prevalent and costly healthcare problems. Graded motor imagery (GMI) is a therapeutic tool that has been successfully used to improve pain in several chronic conditions. GMI therapy is divided into three stages: laterality training (LRJT, Left Right Judgement Task), imagined movements, and mirror therapy. No tool that allows working with LRJT in pelvic floor has been developed to date.

OBJECTIVE

This research aims to describe the process followed for the development of a highly usable, multi-language and multi-platform mobile application using GMI with LRJT to improve the treatment of patients with CPP. In addition, this will require achieving two other goals: firstly, to generate 550 pelvic floor images and, subsequently, to carry out an empirical study to objectively classify them into different difficulty levels of. This will allow the app to properly organize and plan the different therapy sessions to be followed by each patient.

METHODOLOGY

For the design, evaluation and development of the app, an open methodology of user-centered design (MPIu + a) was applied. Furthermore, to classify and establish the pelvic floor images of the app in different difficulty levels, an observational, cross-sectional study was conducted with 132 volunteers through non-probabilistic sampling.

RESULTS

On one hand, applying MPIu+a, a total of 5 phases were required to generate an easy-to-use mobile application. On the other hand, the 550 pelvic floor images were classified into 3 difficulty levels (based on the percentage of correct answers and response time used by the participants in the classification process of each image): Level 1 (191 images with Accuracy = 100 % and RT = [0-2.5] seconds); Level 2 (208 images with Accuracy = 75-100 % and RT = [2.5-5] seconds); and Level 3 (151 images with Accuracy = 50-75 % and RT > 5 s).

CONCLUSION

App-Mohedo® is the first multi-platform, multi-language and easy-to-use mobile application that, through GMI with LRJT, and with an adequate bank of images classified into three levels of difficulty, can be used as a complementary therapeutic tool in the treatment of patients with CPP. This work can also serve as an example, model or guide when applying a user-centered methodology, as MPIu + a, to the development of other apps, especially in the field of health.