Effect of Telerehabilitation-Based Motor Imagery Training on Pain and Related Factors in People with Multiple Sclerosis: Randomized Controlled Pilot Trial.

Objectives: To investigate the effect of telerehabilitation-based graded motor imagery (MI,GMI) training on pain and pain-related factors in people with multiple sclerosis (MS).

Design: Randomized controlled, assessor-blind pilot trial with repeated measure design.

Setting: Neurology outpatient clinic.

Participants: Thirty-two people with MS were randomly allocated to intervention (n=16) and control (n=16) groups.

Interventions: During 8-week GMI training period, the first 2-weeks involved implicit MI training while 6-weeks explicit MI training were conducted.

Main outcome: The primary outcome was the general pain intensity over the past two days, assessed with Visual Analogue Scale, with a minimum clinically important difference (MCID) of 23 mm. Secondary outcomes included general pain and specific body parts' pain intensity over the past seven days, neuropathic pain intensity, MI ability, fatigue, depression, anxiety, quality of life, sleep quality, daytime sleepiness and cognitive functions scores. Assessments were conducted at baseline, at weeks 8 (post-treatment) and 12 (follow-up).

Results: The intervention group demonstrated a significant reduction in pain intensity over the past two days compared to control group (p<0.05). Furthermore, at the 8-week assessment, the intervention group surpassed the MCID in pain intensity over the past 2 and 7 days (p<0.05), whereas no significant change was observed in the control group (p>0.05). Significant effects were observed post-treatment on general pain over the past seven days, neuropathic pain, MI ability, fatigue, depression, quality of life, processing speed, and visuospatial memory within intervention group compared to control group (p<0.05). However, the impact on anxiety, sleep quality, daytime sleepiness, and verbal memory between groups were not significant (p>0.05).

Conclusion: Telerehabilitation-based GMI training stands out as viable for management of chronic pain and pain-related psychosocial symptoms for people with MS.