Motor imagery and action observation for knee and hip osteoarthritis: systematic review and meta-analysis

PURPOSE: Knee and hip osteoarthritis (OA) is a leading cause of disability in older adults. Movement representation strategies, including motor imagery (MI) and action observation (AO), engage motor simulation processes with potential clinical effects in OA. This systematic review and meta-analysis evaluated combined MI and AO on pain, mobility, and disability in knee or hip OA. MATERIALS AND METHODS: We systematically searched Medline (PubMed), PEDro, Embase, Cochrane and EBSCO through March 2026, including randomized controlled trials. Risk of bias was assessed with the Cochrane Risk of Bias 2.0 tool, and certainty of evidence with GRADE. Two independent reviewers performed the assessments, disagreements were resolved by consensus or a third reviewer. RESULTS: = 706) were included. Combined MI and AO reduced pain (SMD -0.86, 95% CI: -1.42 to -0.30), improved functional performance (Timed Up and Go: SMD -0.53, 95% CI: -0.86 to -0.21), and decreased disability (WOMAC: SMD -1.07, 95% CI: -1.83 to -0.32), with moderate heterogeneity in some outcomes. Range of motion also improved (SMD 0.40, 95% CI: 0.34 to 0.46). GRADE certainty ranged from very low to moderate. CONCLUSIONS: Combined AO and MI may reduce pain and disability and improve function in knee and hip OA; higher-quality trials are needed to confirm effects.