Graded Motor Imagery and Task-Oriented Exercise in Shoulder Impingement

NCT07290660 | Recruiting

• 1 other identifier: FBU
• Study Type: interventional
• Target: 66
• Locations: 1 country
• Sites: 1

Brief Summary

This study aims to compare the effects of graded motor imagery and task-oriented exercise training in individuals with shoulder impingement syndrome. A total of 66 participants aged 25-65 years will be randomly assigned to one of three groups: conventional physiotherapy, graded motor imagery, or task-oriented exercise training. All groups will receive standardized electrotherapy, while the intervention groups will additionally complete 6-week graded motor imagery or task-oriented exercise programs. Primary outcomes include pain intensity, shoulder range of motion, muscle strength, proprioception, functional status, kinesiophobia, laterality recognition, movement imagery ability, and patient satisfaction. Assessments will be conducted before and after the intervention by the same physiotherapist. The study aims to determine whether motor imagery-based or task-oriented rehabilitation provides additional benefits compared with conventional physiotherapy in individuals with shoulder impingement syndrome.

Conditions

Pain; Shoulder Impingement Syndrome; Motor Imagery Training; Task Oriented Training

Keywords

Shoulder impingement syndrome; Graded motor imagery; Task-oriented exercise; Rehabilitation; pain

Outcome Measures

Primary Outcomes (6)

• Assessment of Muscle Strength

  Muscle strength will be assessed using the Lafayette Manual Muscle Tester (MMT). Shoulder flexion, extension, abduction, internal rotation, and external rotation muscle strengths will be evaluated. Three consecutive measurements will be taken for each movement, and the mean value will be recorded.

  At baseline and at the end of the 6-week intervention period

• Assessment of Pain Intensity

  Pain intensity will be assessed using a 10 cm Visual Analog Scale (VAS), ranging from '0' (no pain) to '10' (unbearable pain). Participants will rate their pain levels before and after the intervention in three conditions: at rest, during activity, and at night

  At baseline and at the end of the 6-week intervention period

• Assessment of Pain Threshold

  The pain threshold will be assessed using an algometer, a device that measures the pressure at which pain is first perceived. During the measurement, the participant must remain in a relaxed position, and the tip of the algometer must be applied at a 90-degree angle to the tissue. As pressure gradually increases, the participant will be instructed to indicate the moment when pain or discomfort is first felt. This point will be recorded as the pain threshold . In this study, the Commander Echo Algometer will be used to assess pain thresholds. Measurements will be taken from the deltoid muscle, supraspinatus muscle, infraspinatus muscle, and the participant's self-reported most painful area. Each measurement will be repeated three times, and the mean value will be recorded.

  At baseline and at the end of the 6-week intervention period

• Assessment of Shoulder Range of Motion

  Shoulder range of motion will be assessed using a Baseline goniometer (RMS UK Ltd., Nailsea). The joint movements to be evaluated include flexion, extension, abduction, internal rotation, and external rotation, and the results will be recorded in degrees. For each movement, three consecutive measurements will be taken, and the mean value will be used for analysis

  At baseline and at the end of the 6-week intervention period

• Assessment of Active Joint Position Sense

  Active shoulder joint position sense will be assessed using a smartphone goniometer application with proven validity and reliability. Elevation angles of 40° and 100° in the scapular plane will be tested. A smartphone will be placed in an armband positioned over the biceps brachii on the tested side. With eyes open, participants will first learn the target angle through passive movement. Then, with eyes closed, the shoulder will be passively positioned at the target angle three times for familiarization. Participants will then actively reproduce the angle. The test will be repeated six times with 5 seconds of rest between trials. The same procedure will be performed for both 40° and 100° elevations on both shoulders.

  At baseline and at the end of the 6-week intervention period

• Assessment of Upper Extremity Function

  Functional assessment of the shoulder will be performed using the Shoulder Pain and Disability Index (SPADI). SPADI consists of 13 items divided into two subscales: pain and disability. The pain subscale includes five questions related to shoulder pain during activities, while the disability subscale includes eight questions evaluating difficulty in performing daily activities. Both subscale scores and the total score range from 0 to 100, with higher scores indicating greater pain and disability

  At baseline and at the end of the 6-week intervention period

Secondary Outcomes (4)

• Assessment of Laterality Recognition

  At baseline and at the end of the 6-week intervention period

• Assessment of Movement Imagery Ability

  At baseline and at the end of the 6-week intervention period

• Assessment of Kinesiophobia

  At baseline and at the end of the 6-week intervention period

• Assessment of Patient Satisfaction

  It will be assessed at the end of the 6-week treatment period.

Study Arms (3)

Conventional Physiotherapy

ACTIVE COMPARATOR

Participants in this group will receive conventional physiotherapy, including standardized electrotherapy and routine therapeutic exercises for shoulder impingement syndrome, for 6 weeks

Other: Electrotherapy + Conventional Exercise Group

Graded Motor Imagery

ACTIVE COMPARATOR

Participants in this group will receive a 6-week graded motor imagery program in addition to standardized electrotherapy

Other: Electrotherapy + Conventional Exercise Group; Other: The graded motor imagery program

Task-Oriented Exercise Training

ACTIVE COMPARATOR

Participants in this group will receive a 6-week task-oriented exercise training program in addition to standardized electrotherapy.

Other: Electrotherapy + Conventional Exercise Group; Other: The task-oriented exercise program

Interventions

The graded motor imagery program OTHER

The graded motor imagery program consists of 2 weeks of laterality training, 2 weeks of motor imagery, and 2 weeks of mirror therapy. Laterality training will be performed using the Recognise™ Shoulder app (NOI), where participants identify whether presented images show a right or left shoulder. Training will be conducted twice weekly for 2 weeks. Motor imagery includes viewing shoulder movement images (flexion 180°, abduction 180°, external rotation 90°, internal rotation 90°, extension 45°) and mentally rehearsing the movements for 3 sets of 10 repetitions. Mirror therapy requires participants to view the reflection of their unaffected shoulder and perform the imagined movements. Mirror therapy will also be applied twice weekly for 2 weeks, with 3 sets of 10 repetitions

Graded Motor Imagery

Electrotherapy + Conventional Exercise Group OTHER

All participants will receive an electrotherapy program consisting of TENS (100 Hz, 20 minutes), ultrasound (1.5 W/cm², 6 minutes), and cold pack application (15 minutes), delivered 5 days per week for 6 weeks. The conventional exercise program includes wand exercises (flexion, abduction, extension, external/internal rotation), Codman exercises in multiple directions, and finger ladder exercises with a 5-second hold at end range. Strengthening exercises will be performed without resistance during the first week, followed by progressive TheraBand® resistance from week two. Posterior, anterior, and inferior capsule stretching, pectoral stretching, and shoulder-scapular mobilization will be performed under physiotherapist supervision. Exercises will be applied twice weekly for 6 weeks, with 3 sets of 10 repetitions.

Conventional Physiotherapy; Graded Motor Imagery; Task-Oriented Exercise Training

The task-oriented exercise program OTHER

The task-oriented exercise program is based on daily activities related to DASH and SPADI items, focusing on functional shoulder movements including flexion, abduction, extension, and rotation. Exercises will be performed twice weekly for 6 weeks, 3 sets of 10 repetitions. Weeks 0-2 include placing an object on a front shelf, placing an object on a side shelf, placing the hand on the back, touching the neck, washing a plate, and wiping a wall within pain limits. Weeks 2-4 include changing an overhead light bulb, washing hair, combing hair, putting on and taking off a pullover shirt, and donning a jacket or cardigan. Weeks 4-6 include placing a 0.5-kg weight on an overhead shelf (front and side), washing or scratching the upper and lower back, and placing a wallet in the back pocket.

Task-Oriented Exercise Training

Eligibility Criteria

• Age: 25 Years - 65 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Diagnosed with Stage I or Stage II shoulder impingement syndrome by an Orthopedics or Physical Medicine and Rehabilitation physician
• Positive Neer and Hawkins tests
• Unilateral shoulder pain for at least 3 months
• No participation in any physiotherapy program for shoulder problems within the last year
• Ability to cooperate and follow instructions
• A score of 24 or above on the Standardized Mini-Mental Test -

You may not qualify if:

• History of previous shoulder surgery
• Local corticosteroid injection within the last three months
• Presence of uncontrolled neurological, cardiac, or systemic diseases that may interfere with function
• Cognitive impairments that may affect proper understanding or execution of the motor imagery program
• A score below 24 on the Standardized Mini-Mental Test

Sponsors & Collaborators

• Fenerbahce University: lead

Study Sites (1)

Istanbul Medipol University, Institute of Health Sciences

Istanbul, Turkey (Türkiye)

RECRUITING

MeSH Terms

Conditions

Shoulder Impingement Syndrome; Pain

Interventions

Electric Stimulation Therapy

Condition Hierarchy (Ancestors)

Joint Diseases; Musculoskeletal Diseases; Shoulder Injuries; Wounds and Injuries; Neurologic Manifestations; Signs and Symptoms; Pathological Conditions, Signs and Symptoms

Intervention Hierarchy (Ancestors)

Therapeutics; Physical Therapy Modalities; Rehabilitation

Central Study Contacts

Yeliz Çırak, PT, MSc

CONTACT

05373298320; yeliz.cirak@fbu.edu.tr

Gülay Aras Bayram, Assoc. Prof.

CONTACT

05054966284; garas@medipol.edu.tr

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Principal Investigator

Model Details: This study uses a three-arm parallel-group design. Participants will be randomly assigned to one of three groups: conventional physiotherapy, graded motor imagery, or task-oriented exercise training. All groups will receive a 6-week intervention without crossover

Study Record Dates

• First Submitted: December 5, 2025
• First Posted: December 18, 2025
• Study Start: December 1, 2025
• Primary Completion (Estimated): December 30, 2026
• Study Completion (Estimated): December 30, 2026
• Last Updated: December 18, 2025

Record last verified: 2025-12

Data Sharing

• IPD Sharing: Will not share

Locations

TU (1)