Graded motor imagery for patients with stroke: a non-randomised controlled trial of a new approach

BACKGROUND : Graded motor imagery (GMI) is a new approach that is thought to promote graded cortical brain activation and may promote motor recovery after stroke. AIM: This non-randomized controlled trial investigated the feasibility and clinical effect of GMI in motor recovery after stroke. DESIGN: Non-randomized controlled trial. SETTING: Inpatient subjects of neurorehabilitation hospital. POPULATION: Twenty-eight patients (i.e. 14 experimental and 14 control matched) with first-ever stroke. METHODS: Patients were assessed before and after a 4-week intervention. Assessors were blinded to the protocol. The experimental group underwent 20 sessions (1-hour each) based on GMI principles; the control group received the same amount of conventional rehabilitation. Primary outcomes were Wolf Motor Function Test (WMFT ) and the 66-points motor section of the Fugl-Meyer Assessment (FMA). RESULTS: Groups were comparable under demographical and clinical features. Mean duration since stroke was 19 weeks. Patients were satisfied and adhered well to the protocol. Ten patients in the GMI group and four in the control group reached the minimal clinically important difference. Mean (SD) improvement in the GMI group was 0.72 (0.5) for WMFT , and 10.3 (8.9) points for FMA. The control group improved a mean (SD) of 0.21 (0.35) points at WMFT and 2.7 (0.35) points at FMA. Between-group analysis shows that GMI provided significantly greater improvements for both motor functions at WMFT (P=0.05) and in the pain section of FMA (P=0.006), respectively. CONCLUSIONS: GMI is a feasible treatment for stroke patients with better outcomes than conventional therapy. A randomized controlled trial is warranted to minimise risk of selection bias. CLINICAL REHABILITATION IMPACT: Clinicians should implement GMI treatment in their clinical practice, being a feasible, clinically relevant, costless, and easy-to-do treatment.