Critically appraised paper: Online graded motor imagery is effective in women diagnosed with pelvic pain synopsis

Yvonne C Learmonth

doi:10.1016/j.jphys.2025.08.004

Summary of: Lopez-Brull A, Perez-Dominguez B, Plaza-Carrasco M, Blasco-Ortiz C, Navarro-Ribera B, Casaña J, et al. Online graded motor imagery is effective in women diagnosed with pelvic pain: a randomized controlled trial. Phys Ther. 2025:105:pzae164. Question: Does an online graded motor imagery (GMI) program reduce pain intensity and improve sexual function in women diagnosed with genito-pelvic pain/penetration disorder compared with no treatment? Design: Parallel-group, randomised, controlled trial with concealed allocation and blinded assessors. Setting: Physiotherapy clinics specialised in pelvic floor disorders in Valencia, Spain. Participants: Eligible participants were women aged >18 years who experienced pain with vaginal penetration during sexual intercourse for ≥ 6 months and who scored > 6 points on the Chronic Pelvic Pain questionnaire (0 to 27 scale). Key exclusion criteria were other medical conditions that could explain pain with vaginal penetration during sexual intercourse. One-to-one randomisation of 87 participants allocated 43 to the GMI group and 44 to a control group. Interventions: Participants in the GMI group received a tailored online program for pelvic pain, aligning with principles of neuroplasticity. It consisted of three 2-week phases over 6 weeks. In phase 1 (implicit motor imagery exercise), participants viewed pain-related images of the abdominoperineal area and judged left/right perspectives via an app. In phase 2 (explicit motor imagery exercise), participants listened to six audio recordings and imagined several exercises, with the recordings representing a gradual progression of potential painful activities. In phase 3, participants followed a graded exposure exercise program, starting with genital exploration and ending in intercourse. Researchers contacted participants over the 6 weeks to ensure adherence and address queries. The control group received no intervention during the study period. Outcome measures: The primary outcomes were pain intensity assessed using a visual analogue scale (0 to 10 cm) and sexual function assessed using the short form Female Sexual Function Index (FSFI-6, 2 to 30) at 6 weeks. Results: Eighty-three participants (96%) completed the 6-week follow-up. The GMI program resulted in a small but significant reduction in pain intensity (between-group MD –2.0, 95% CI –2.6 to –1.4) but did not result in improved sexual function (between-group MD in FSFI scores 1.1, 95% CI –0.7 to 2.9) when compared with no treatment. Conclusion: In adult women with genito-pelvic pain/penetration disorder, a 6-week online GMI program improved pain intensity but not sexual function compared with no treatment. [95% CIs calculated by the CAP Editor.] Provenance: Invited. Not peer reviewed.

Critically appraised paper: Online graded motor imagery is effective in women diagnosed with pelvic pain synopsis

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