Effectiveness Of Motor Imagery And Deep Neck Flexor Training On Breathing Function, Kinesiophobia, And Activities Of Daily Living In Individuals With Chronic Neck Pain: A Systematic Review And Meta-Analysis

Abstract

Background: Chronic neck pain (CNP) is a common musculoskeletal disorder often associated with impaired respiratory function, heightened kinesiophobia, and reduced capacity for daily activities (ADL). Motor imagery (MI) and deep neck flexor training (DNFT) have been shown to be effective interventions that address both the physical and psychological dimensions of CNP.

Objective: This systematic review and meta-analysis aimed to evaluate the effectiveness of MI and DNFT, both individually and in combination, on breathing function, kinesiophobia, and the performance of ADL in patients suffering from chronic neck pain.

Methods: In accordance with PRISMA guidelines, a systematic review was conducted using PubMed, Scopus, CINAHL, and Web of Science. The inclusion criteria encompassed randomized controlled trials and quasi-experimental studies that assessed MI and/or DNFT interventions in adult CNP populations. Meta-analyses employed random-effects models, and evaluations were made for heterogeneity, sensitivity, and publication bias.

Results: Twenty-one studies were included. The combined intervention of MI+DNFT significantly improved breathing function, reduced kinesiophobia, and enhanced ADL outcomes (overall effect size: 0.712, 95% CI: 0.617–0.806, p < 0.001). Significant heterogeneity (I² = 73.41%) was identified and addressed through subgroup and sensitivity analysis. Both MI and DNFT showed greater effects when used together. Publication bias was found to be low.

Conclusion: MI and DNFT, particularly when used together, serve as effective non-invasive treatments for improving both physical and psychological outcomes in individuals with chronic neck pain. These findings support their integration into rehabilitation protocols, although further research is needed to standardize these protocols and evaluate their long-term effects.