Effectiveness of motor imagery in postoperative outcomes after anterior cruciate ligament reconstruction

Table 1 Study and patient characteristics

Ref.	Study design	Trait of participants	Number of participants	Intervention	Type of imagery	Pre-op session	Duration	Frequency	Age (year)	Sex (male/total)	Mean follow-up
Almuhaya et al[12], 2023	RCT	Cases: 13 ACLR only, 4 ACLR + MMR, 1 ACLR + both (MMR and LMR)	Cases: 16	Cases: Structured education + standard physiotherapy	Virtual interactive structured educational session via Zoom platform including a series of topics related to the surgery and the rehabilitation process prepared with pictures and graphs	No	1 week	8 five days in a week, 2 four days, 8 three or less days	26 (6)	35/35	1 week
		Controls: 12 ACLR only, 2 ACLR + MMR, 1 ACLR + LMR, 2 ACLR + both	Controls: 14	Controls: Standard physiotherapy
Lee et al[14], 2023	RCT	ACL reconstruction	Cases: 55	Cases: Smartphone app-based behavioral intervention + standard physiotherapy	A smartphone app delivering the intervention through text, pictorials, and videos on how post-surgery home-based exercises and rehabilitations will be done, behavior change techniques	No	16 weeks	NR	27.82 (8.73)	NR	16 weeks
			Controls: 41	Controls: Standard physiotherapy
Brewer et al[6], 2022	RCT	ACL reconstruction	Cases: 34	Cases: Interactive cognitive-behavioral multimedia program + standard physiotherapy	Introductory information and instructions on: (1) General information; (2) Surgery; and (3) Rehabilitation. Videos in which an orthopedic surgeon discussed the sensory and procedural aspects associated with the corresponding section of the program. Anatomical and surgical animations, video and still images of preoperative and postoperative rehabilitation exercises, video clips of former ACL reconstruction patients describing their experiences with ACL surgery and rehabilitation, a graph of pain over the rehabilitation process, and written text were among the means by which procedural and sensory information and modeling of adaptive coping responses. Links to online resources, personal accounts of and recommendations for dealing with ACL surgery and rehabilitation from former patients	Yes	24 weeks	Weekly	35.01 (11.98)	39/69	24 weeks
			Placebos: 35	Placebo: Printed educational materials + standard physiotherapy
D’Isanto et al[13], 2022	RCT	ACL reconstruction	Cases: 15	Cases: VRGI and MT + standard physiotherapy	Suggestions for imagining internal images related to the use of the affected limb in one or more functional tasks and also through the mirror box, working with the vision of a video in which, through a background voice, the subject was asked to visualize specific sports movements and gestures	No	20 weeks	3 times per week (training frequency was 5/week with a session length of 60 minutes, with MT added 3 times/week for 20-25 minutes after the end of the conventional physical therapy)	Cases: 33 (1.8)	NR	20 weeks
			Controls: 15	Controls: Physiotherapy					Controls: 32 (1.6)
Lyles et al[17], 2014	RCT	ACL reconstruction	Cases: 15	Cases: Mirror therapy + standard physiotherapy	Affected leg was placed behind a self-made mirror (non-reflecting side) and non-affected leg was placed in front of the mirror (reflecting side). Patients were instructed to observe the reflected leg into the mirror while performing the exercises and then attempt the same exercises with the involved leg	No	6 days	Once a day	Cases: 33.13 (6.99)	Cases: 10/15	6 days
			Controls: 15	Controls: Standard physiotherapy					Controls: 32.4 (5.66)	Controls: 9/15
Rhim et al[8], 2020	RCT	ACL reconstruction	Cases: 10	Cases: Modeling intervention + standard physiotherapy	Cases: Six modeling videos of semi-structured interviews and models who discussed their injury experience, expectations, and recovery and performed postoperative time-matched	Yes	24 weeks	NR	Cases: 27.1 (9.5), placebos: 32.2 (12.2), controls: 26.8 (7.9)	Cases: 9/10, placebos: 8/11, controls: 10/11	24 weeks
			Placebos: 11	Placebos: Placebo videos + standard physiotherapy	Tasks and rehabilitation exercises. Six videos were similar in length (5 minutes)
			Controls: 11	Controls: Standard physiotherapy	Reflected 6 different time points: Preoperative period, from hospitalization to 2 weeks, 2 weeks to 6 weeks, 6 weeks to 3 months, 3 months to 6 months, and 6 months and beyond following ACLR; placebos: Videos of PowerPoint slides including epidemiology of ACL injuries, anatomy of ACL, and mechanisms of ACL injury, and describing rehabilitation exercises with words
Levinger et al[7], 2017	RCT	ACL reconstruction	Cases: 10	Cases: Internet-based resource + usual rehabilitation	Video and images on ACL reconstruction, expected milestones during the recovery process, strategies to overcome distress associated with the injury, and recommended physiotherapy exercises	No	12 weeks	On a daily basis for the first week following the surgery	Cases: 32.2 (10.2)	Cases: 6/10, placebos: 4/7	12 weeks
			Placebos: 7	Placebos: Restricted access to internet-based resource + usual rehabilitation				Three times per week for weeks 2-3 following the surgery	Placebos: 28.5 (9.1)
								Once a week for weeks 4-12 following the surgery
Zaffagnini et al[9], 2013	RCT	ACL reconstruction	Cases: 51	Cases: Therapeutic vision videos + standard physiotherapy	Cases: Art video producing therapeutic insight	No	8 weeks	3 times per week	33 (17)	80/101	12 weeks
			Placebos: 50	Placebos: Videos of unfavorable information + standard physiotherapy	Placebos: Art video with an insight unfavorable to the psychological recovery
Maddison et al[16], 2012	RCT	ACL reconstruction	Cases: 13	Cases: Mental rehearsal of rehabilitation goals + standard physiotherapy	Nine individual sessions of mental rehearsal of activities to achieve physical rehabilitation goals including cognitive, motivational, and healing imagery; cognitive imagery was used to rehearse rehabilitation exercises, using both visual and kinaesthetic modalities. Motivational imagery was used to set goals, control arousal levels, and increase self-confidence. Healing imagery was used to imagine the physiological processes taking place during rehabilitation	No	24 weeks	NR	34.86 (8.84)	13/21	24 weeks
			Controls: 8	Controls: Standard physiotherapy
Lebon et al[4], 2012	RCT	ACL reconstruction	Cases: 7	Cases: Imagining muscle contractions + standard physiotherapy	3 blocks of 10 imagined contractions, with a 10-second rest period between rehearsals and 2-minute rest period between blocks	No	5 weeks	Every 2 days	28.5 (5)	NR	5 weeks
			Placebos: 5	Placebos: Neutral mental task (crossword or calculation) + standard physiotherapy
Maddison et al[15], 2006	RCT	ACL reconstruction	Cases: 30	Cases: Coping-model video + standard physiotherapy	Two coping model videos of edited interviews and models performing rehabilitation exercises; first video pre-op to 2 weeks post-op (9-minute) and second video 2 weeks to 6 weeks post-op (7-minute)	Yes	6 weeks	NR	30	NR	6 weeks
			Controls: 28	Controls: Standard physiotherapy
Cupal and Brewer[3], 2001	RCT	ACL reconstruction	Cases: 10	Cases: Mental rehearsal of rehabilitation goals + standard physiotherapy	Videos of patient’s arthroscopic procedure, facilitating knee flexibility and ROM, edema reduction, knee strength, position sense, anxiety reduction, anatomical and neurological mental comparison	No	24 weeks	Every 2 weeks	28.2 (8.2)	16/30	24 weeks
			Placebos: 10	Placebos: Peaceful scene imagery + attention, encouragement, and support + standard physiotherapy
			Controls: 10	Controls: Standard physiotherapy

MMR: Medial meniscus repair; LMR: Lateral meniscus repair; VRGI: Virtual reality-guided imagery; MT: Mirror therapy; RCT: Randomized controlled trial; ACL: Anterior cruciate ligament; ACLR: Anterior cruciate ligament reconstruction; ROM: Range of motion; NR: Not reported.