Differential changes in cervical proprioception and motor imagery following structured imagery training in chronic neck pain
- 1Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Bahcesehir University, Istanbul, Turkey
- 2Department of Physiotherapy and Rehabilitation, Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
- 3Neuroscience Research Center, Research Institute for Health Sciences and Technologies (SABITA), Istanbul Medipol University, Istanbul, Turkey
Abstract
Background: Chronic neck pain (CNP) is associated with altered sensorimotor function, including impairments in cervical proprioception and changes in body-related perception. While implicit motor imagery (IMI)–based interventions have shown clinical benefits, their effects on cervical proprioceptive performance and motor imagery-related outcomes in individuals with CNP remain unclear. Objective: To investigate the effects of lateralization and IMI training on cervical proprioception (CP), neck awareness (NA), IMI performance, pain, disability, kinesiophobia, and range of motion (ROM) in individuals with CNP. Methods: In this clinical trial, 34 participants (17 CNP, 17 healthy controls) completed a 4-week structured imagery training (SIT) program combining lateralization and IMI training delivered via telerehabilitation. Primary outcome was cervical joint position error (JPE). Secondary outcomes included IMI performance (left/right judgment task), pain, disability, kinesiophobia, NA, ROM, and cognitive interference (Stroop). Results: Following SIT, the CNP group showed statistically significant within-group reductions in pain intensity (Holm-adjusted p = 0.012, d = 0.76), kinesiophobia (Holm-adjusted p = 0.034, d = 0.50), neck-related disability (Holm-adjusted p = 0.034, d = 0.37), and FreNAQ-T scores (Holm-adjusted p = 0.012, d = 0.09). However, baseline-adjusted models revealed no statistically significant between-group post-training differences for extension JPE (p > 0.05, partial η2 = 0.009), flexion JPE (where post-training values remained persistently elevated in CNP; partial η2 = 0.310), and IMI accuracy/reaction times for neck and hand tasks (all Holm-adjusted p = 1.000, partial η2 ≤ 0.068). Conclusions: A 4-week SIT program was associated with short-term improvements in subjective clinical symptoms in individuals with CNP; however, no differential group effects were observed for objective cervical proprioception or motor imagery performance.
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BibTeX
@article{bostan2026differential,
title = {{Differential changes in cervical proprioception and motor imagery following structured imagery training in chronic neck pain}},
author = {Aysegul Bostan and Aysenur Akan and Ozlem Ulger},
journal = {PLOS One},
year = {2026},
month = nov,
doi = {10.1371/journal.pone.0361409},
url = {https://doi.org/10.1371/journal.pone.0361409},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Differential changes in cervical proprioception and motor imagery following structured imagery training in chronic neck pain
AU - Aysegul Bostan
AU - Aysenur Akan
AU - Ozlem Ulger
PY - 2026
DA - 2026/11/05
JO - PLOS One
DO - 10.1371/journal.pone.0361409
UR - https://doi.org/10.1371/journal.pone.0361409
AB - Background: Chronic neck pain (CNP) is associated with altered sensorimotor function, including impairments in cervical proprioception and changes in body-related perception. While implicit motor imagery (IMI)–based interventions have shown clinical benefits, their effects on cervical proprioceptive performance and motor imagery-related outcomes in individuals with CNP remain unclear. Objective: To investigate the effects of lateralization and IMI training on cervical proprioception (CP), neck awareness (NA), IMI performance, pain, disability, kinesiophobia, and range of motion (ROM) in individuals with CNP. Methods: In this clinical trial, 34 participants (17 CNP, 17 healthy controls) completed a 4-week structured imagery training (SIT) program combining lateralization and IMI training delivered via telerehabilitation. Primary outcome was cervical joint position error (JPE). Secondary outcomes included IMI performance (left/right judgment task), pain, disability, kinesiophobia, NA, ROM, and cognitive interference (Stroop). Results: Following SIT, the CNP group showed statistically significant within-group reductions in pain intensity (Holm-adjusted p = 0.012, d = 0.76), kinesiophobia (Holm-adjusted p = 0.034, d = 0.50), neck-related disability (Holm-adjusted p = 0.034, d = 0.37), and FreNAQ-T scores (Holm-adjusted p = 0.012, d = 0.09). However, baseline-adjusted models revealed no statistically significant between-group post-training differences for extension JPE (p > 0.05, partial η2 = 0.009), flexion JPE (where post-training values remained persistently elevated in CNP; partial η2 = 0.310), and IMI accuracy/reaction times for neck and hand tasks (all Holm-adjusted p = 1.000, partial η2 ≤ 0.068). Conclusions: A 4-week SIT program was associated with short-term improvements in subjective clinical symptoms in individuals with CNP; however, no differential group effects were observed for objective cervical proprioception or motor imagery performance.
SN - 1932-6203
ER -