Effectiveness of motor imagery and action observation on functional variables: An umbrella and mapping review with meta-meta-analysis

Abstract

To assess the current evidence on motor imagery (MI) and action observation (AO) and their influence on functional variables. We conducted 3 meta-meta-analyses (MMA) to determine the effectiveness of MI and AO on arm functionality, performance on activities of daily living and gait mobility in stroke patients. For arm functionality, MMA revealed a statistically significant large effect size (standardised mean difference [SMD] = 1.05; 95 % CI 0.50-1.60; p<.001) but with evidence of heterogeneity (Q=55.67, p<.001, I²=93 %). For arm performance in activities of daily living, MMA revealed a significantly large effect size (SMD=1.76; 95 % CI 1.10-2.43; p<.001) but also with evidence of heterogeneity (Q=1.62, p=.44, I²=90 %). MMA showed no significant effects favouring intervention regarding gait mobility. The results of the systematic reviews showed that movement representation techniques combined with the usual treatment have a positive impact on improving function, with a very low to moderate quality of evidence for all variables except for range of motion in acute disorders and strength. MI and AO showed positive results for improving functional variables.

Keywords: Action observation; Activities of daily living; Arm function; Gait mobility; Motor imagery; Muscle strength; Postural balance; Range of motion.