Effects of motor imagery and action observation combined with standard rehabilitation on walking distance in people with multiple sclerosis: A single-blind exploratory randomized controlled trial

BACKGROUND: Motor imagery (MI) and action observation (AO) in people with multiple sclerosis (pwMS) have not been compared. OBJECTIVE: To explore the effects of MI and AO, each combined with standard rehabilitation, on walking, fatigue, and trunk control in pwMS. METHODS: Forty-eight pwMS (Expanded Disability Status Scale < 4.0) were randomized into MI, AO, or control groups (1:1:1). All groups received standard rehabilitation (40 min/session, three times weekly for 6 weeks). The MI and AO groups additionally performed 20 minutes of MI or AO per session. The primary outcome was walking distance (6-Minute Walk Test). Secondary outcomes included walking-related parameters, fatigue, and trunk control. RESULTS: = 0.006). Both interventions also resulted in greater improvements in walking-related outcomes and fatigue. Trunk control outcomes were similar across all groups, with no differences between the MI and AO groups for any outcome. CONCLUSIONS: MI and AO appear to be useful adjuncts to standard rehabilitation for enhancing walking and reducing fatigue in pwMS. However, their effects on trunk control were limited, and no superiority was observed between approaches.