Effectiveness of adding motor imagery to telerehabilitation for nonspecific low back pain: A pilot randomized controlled trial

J Bodyw Mov Ther. 2026 Jul;47:361-370. doi: 10.1016/j.jbmt.2026.04.014. Epub 2026 Apr 29.

ABSTRACT

BACKGROUND: Nonspecific low back pain (NSLBP) is a leading cause of disability worldwide. Although exercise therapy is first-line management, persistent symptoms suggest that targeting neurocognitive and sensorimotor processes may enhance outcomes.

OBJECTIVE: To explore the preliminary effects of integrating motor imagery into a telerehabilitation-based exercise program in individuals with NSLBP.

DESIGN: Assessor-blinded pilot randomized controlled trial.

METHODS: Thirty-six participants with NSLBP were randomized to telerehabilitation-based motor imagery training (TR-MIT) or telerehabilitation-based exercise training (TR-ET) (n = 18 per group). Interventions were delivered twice weekly for 10 weeks. As a pilot study, the primary aim was to assess feasibility and estimate treatment effects for a future definitive trial. Outcomes included pain (VAS), disability (Oswestry Disability Index), lumbar flexibility, trunk endurance, motor imagery performance, body awareness, and selected cognitive measures. Group × time interactions were analyzed, and effect sizes with 95% confidence intervals were calculated. Analyses were performed per protocol.

RESULTS: TR-MIT produced greater improvements than TR-ET in pain and disability, with additional between-group differences in flexibility, trunk endurance, motor imagery performance, body awareness, and selected cognitive outcomes (p < 0.05). Reductions in disability exceeded commonly reported minimal clinically important difference thresholds. Effect sizes were moderate to large, though confidence intervals reflected pilot-level precision. Adherence was high, and no adverse events occurred.

CONCLUSION: Within a pilot randomized design, adding motor imagery to telerehabilitation-based exercise was associated with greater improvements in pain and disability than exercise alone in NSLBP. Larger trials are needed to confirm these findings.

CLINICAL TRIAL REGISTRATION: NCT05049772.

PMID:42264815 | DOI:10.1016/j.jbmt.2026.04.014