Impact of motor guided imagery therapy on stroke patients with pain symptoms: a three-level meta-analysis and systematic review of randomized controlled trials.
5 affiliations
- 1Institute of Physical Education and Training, Capital University of Physical Education and Sports, Beijing, China.
- 2School of Recreation and Community Sport, Capital University of Physical Education and Sports, Beijing, China.
- 3The High School Affiliated to Beijing Jiaotong University, Beijing, China, 3Shenyang Normal University, Beijing, China.
- 4College of Sports Science, Shenyang Normal University, Shenyang, China.
- 5School of Ice‑Snow Sports, Capital University of Physical Education and Sports, Beijing, China.
Abstract
Background
Post-stroke pain is a common and intractable complication that hinders neurorehabilitation progress. Motor Guided Imagery (MGI), an emerging rehabilitation technique based on brain-computer interaction principles, has shown potential in relieving post-stroke pain, yet high-quality evidence on its multi-dimensional efficacy remains insufficient. This study aimed to systematically evaluate the effects of MGI on pain, sensorimotor function, sleep quality, life status, and psychological mood in stroke patients using a three-level meta-analysis.Objective
This study aimed to quantitatively assess the therapeutic effects of Motor Guided Imagery for stroke-related pain and explore potential intervention moderators using a three-level meta-analysis framework.Methods
Eight Chinese and English databases were searched from inception to June 29, 2025, to collect randomized controlled trials (RCTs) of MGI for stroke patients with pain. A three-level random-effects model was adopted to pool Hedges' g effect sizes, accompanied by heterogeneity testing, moderator analysis, influence analysis, and publication bias assessment. Influence-based outlier detection was implemented; analyses retaining all effect-size observations were treated as the primary main analysis, while outlier-removed analyses were reported only as supplementary sensitivity checks.Results
Motor-guided imagery training significantly relieved pain (g = -0.524, 95% CI -0.779 to -0.269, p = 0.0006; negative Hedges' g indicates clinical improvement for this outcome) and improved sleep quality (g = -1.658, 95% CI -2.115 to -1.201, p < 0.001; negative Hedges' g indicates clinical improvement for this outcome) in stroke patients. Meanwhile, it significantly enhanced motor function (g = 1.395, 95% CI 0.963 to 1.826, p < 0.001), life status (g = 1.757, 95% CI 0.966 to 2.549, p = 0.0012), and psychological-emotional status (g = 1.729, 95% CI 1.045 to 2.413, p = 0.0002); positive Hedges' g indicates clinical improvement for the latter three outcomes. Moderator analysis indicated that acute-phase intervention (≤4 weeks) and high-frequency regimens (>5 sessions/week) tended to produce better analgesic effects, while age, gender, single-session duration, and pain location had no significant moderating effects.Conclusion
MGI may produce beneficial rehabilitation effects that can alleviate post-stroke pain and synergistically improve motor function, sleep, daily-living ability, and psychological state of stroke patients. Exploratory subgroup trends indicated potentially larger effects for early implementation within the acute phase and high-frequency short-duration regimens. However, these observations should be interpreted as hypothesis-generating clues given non-significant overall moderator tests. Further high-quality research is required to confirm these findings.Registration
The systematic review protocol was retrospectively registered with PROSPERO under registration ID CRD420261278812, after literature search and full-text screening had been completed.Systematic review registration
https://www.crd.york.ac.uk/PROSPERO/view/CRD420261278812; identifier: CRD420261278812.
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BibTeX
@article{li2026impact,
title = {{Impact of motor guided imagery therapy on stroke patients with pain symptoms: a three-level meta-analysis and systematic review of randomized controlled trials.}},
author = {Xinmo Li and Hong Ni and Guangze Cui and Chen Wei and Yongguo Zhu},
journal = {Frontiers in neurology},
year = {2026},
month = oct,
doi = {10.3389/fneur.2026.1920523},
url = {https://europepmc.org/article/MED/42904129},
note = {CC BY},
}
RIS
TY - JOUR
TI - Impact of motor guided imagery therapy on stroke patients with pain symptoms: a three-level meta-analysis and systematic review of randomized controlled trials.
AU - Xinmo Li
AU - Hong Ni
AU - Guangze Cui
AU - Chen Wei
AU - Yongguo Zhu
PY - 2026
DA - 2026/10/06
JO - Frontiers in neurology
DO - 10.3389/fneur.2026.1920523
UR - https://europepmc.org/article/MED/42904129
AB - Background Post-stroke pain is a common and intractable complication that hinders neurorehabilitation progress. Motor Guided Imagery (MGI), an emerging rehabilitation technique based on brain-computer interaction principles, has shown potential in relieving post-stroke pain, yet high-quality evidence on its multi-dimensional efficacy remains insufficient. This study aimed to systematically evaluate the effects of MGI on pain, sensorimotor function, sleep quality, life status, and psychological mood in stroke patients using a three-level meta-analysis.Objective This study aimed to quantitatively assess the therapeutic effects of Motor Guided Imagery for stroke-related pain and explore potential intervention moderators using a three-level meta-analysis framework.Methods Eight Chinese and English databases were searched from inception to June 29, 2025, to collect randomized controlled trials (RCTs) of MGI for stroke patients with pain. A three-level random-effects model was adopted to pool Hedges' g effect sizes, accompanied by heterogeneity testing, moderator analysis, influence analysis, and publication bias assessment. Influence-based outlier detection was implemented; analyses retaining all effect-size observations were treated as the primary main analysis, while outlier-removed analyses were reported only as supplementary sensitivity checks.Results Motor-guided imagery training significantly relieved pain (g = -0.524, 95% CI -0.779 to -0.269, p = 0.0006; negative Hedges' g indicates clinical improvement for this outcome) and improved sleep quality (g = -1.658, 95% CI -2.115 to -1.201, p < 0.001; negative Hedges' g indicates clinical improvement for this outcome) in stroke patients. Meanwhile, it significantly enhanced motor function (g = 1.395, 95% CI 0.963 to 1.826, p < 0.001), life status (g = 1.757, 95% CI 0.966 to 2.549, p = 0.0012), and psychological-emotional status (g = 1.729, 95% CI 1.045 to 2.413, p = 0.0002); positive Hedges' g indicates clinical improvement for the latter three outcomes. Moderator analysis indicated that acute-phase intervention (≤4 weeks) and high-frequency regimens (>5 sessions/week) tended to produce better analgesic effects, while age, gender, single-session duration, and pain location had no significant moderating effects.Conclusion MGI may produce beneficial rehabilitation effects that can alleviate post-stroke pain and synergistically improve motor function, sleep, daily-living ability, and psychological state of stroke patients. Exploratory subgroup trends indicated potentially larger effects for early implementation within the acute phase and high-frequency short-duration regimens. However, these observations should be interpreted as hypothesis-generating clues given non-significant overall moderator tests. Further high-quality research is required to confirm these findings.Registration The systematic review protocol was retrospectively registered with PROSPERO under registration ID CRD420261278812, after literature search and full-text screening had been completed.Systematic review registration https://www.crd.york.ac.uk/PROSPERO/view/CRD420261278812; identifier: CRD420261278812.
SN - 1664-2295
ER -