Effect of Graded Motor Imagery on Shoulder Dysfunction Post Mastectomy

One of the most common complications after breast cancer surgery is a functional limitation of the upper body. Up to 67% of breast cancer patients experience arm or shoulder impairment, including pain, numbness, loss of strength, and reduced ROM, after surgery.

Graded motor imagery is effective in reducing pain interference with function using a graded sequence of strategies including left/right judgements (implicit motor imagery), imagined movements (explicit motor imagery) and mirror therapy.

Study Overview

• Status: Completed
• Conditions: Shoulder Dysfunction
• Intervention / Treatment: Other: Graded Motor Imagery (GMI); Other: Physical therapy program

Detailed Description

54 female patients who have shoulder dysfunction post-mastectomy will participate in this study. Their ages will be ranged 35 to 55 years.

In this study the patients will be randomly assigned into two equal groups (27 patients for each group):

1. Group A (study group):

   This group includes 27 patients who will receive graded motor imagery (GMI) along with the conventional physiotherapy (It will include exercise like codman's pendulum exercises in flexion-extension, abduction-adduction, and circular motion, active assisted ROM exercises with a wand, capsular stretching, wall ladder, and shoulder wheel exercises). GMI is consists of a three-step process. Each step of will be carried out for two weeks, for 30 minutes on two separate days, for total 6 weeks.

2. Group B (control group):

This group includes 27 patients who will receive conventional physiotherapy treatment. It will include exercise like codman's pendulum exercises in flexion-extension, abduction-adduction, and circular motion, active assisted ROM exercises with a wand, capsular stretching, wall ladder, and shoulder wheel exercises, 2 times / week for 6 weeks.

• Study Type: Interventional
• Enrollment (Actual): 54
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Egypt
  • Giza, Egypt
    • Cairo University

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Age range of 35 to 55 years.
• All patients are post-mastectomized unilaterally.
• Female patients only.
• Patients have shoulder ROM restriction.
• Patients have shoulder pain more than 3 months (chronic).

Exclusion Criteria:

• Having double mastectomy.
• Psychopathological disorders.
• Having other orthopedic problems (e.g. tendinitis, dislocation, osteoarthritis, referred pain to shoulder).
• Motor problems (e.g. tremor, dyskinesia).
• Metastasis.
• Visual impairment such that they could not read unaided or with their reading glasses.
• Having previously received GMI treatment.
• Diabetes mellitus.
• Having neurological problems as hemiplegia.
• Patients with lymphedema

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Double

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Group A (study group); This group includes 27 patients who will receive graded motor imagery (GMI) along with the conventional physiotherapy (It will include exercise like codman's pendulum exercises in flexion-extension, abduction-adduction, and circular motion, active assisted ROM exercises with a wand, capsular stretching, wall ladder, and shoulder wheel exercises). GMI is consists of a three-step process. Each step of will be carried out for two weeks, for 30 minutes on two separate days, for total 6 weeks	Other: Graded Motor Imagery (GMI); Left/right judgements:It includes left/right judgments of photographs that depict the affected area.; Imagined movements:Movement visualizations will be performed.; Mirror therapy: It includes observation of the movements of unaffected body part in the mirror, 2 times / week for 6 weeks.; Other: Physical therapy program; It will include exercise like codman's pendulum exercises in flexion-extension, abduction-adduction, and circular motion, active assisted ROM exercises with a wand, capsular stretching, wall ladder, and shoulder wheel exercises, 2 times / week for 6 weeks.; Other Names: A group of exercises
Placebo Comparator: Group B (control group); This group includes 27 patients who will receive conventional physiotherapy treatment. It will include exercise like codman's pendulum exercises in flexion-extension, abduction-adduction, and circular motion, active assisted ROM exercises with a wand, capsular stretching, wall ladder, and shoulder wheel exercises, 2 times / week for 6 weeks	Other: Physical therapy program; It will include exercise like codman's pendulum exercises in flexion-extension, abduction-adduction, and circular motion, active assisted ROM exercises with a wand, capsular stretching, wall ladder, and shoulder wheel exercises, 2 times / week for 6 weeks.; Other Names: A group of exercises

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Visual analog scale	A validated, subjective measure for acute and chronic pain. Scores are recorded by making a handwritten mark on a 10-cm line that represents a continuum between 0 means "no pain" and 10 means "worst pain."	From baseline to 6 weeks
Smartphone clinometer application	The smartphone clinometer application has excellent agreement with a goniometer-based gold standard for measurement of shoulder ROM in both healthy subjects and symptomatic patients.	From baseline to 6 weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Shoulder Pain and Disability Index	Is a self-administered questionnaire that aims to measure pain and disability associated with shoulder disease with lower scores indicate little pain or disability and higher scores indicate higher pain and disability	From baseline to 6 weeks
Handheld dynamometer	A valid tool for measuring isometric muscle strength in kilograms/newton that provides an objective overview of shoulder flexor and abductor muscles strength	From baseline to 6 weeks

Collaborators and Investigators

• Sponsor: Cairo University
• Investigators: Principal Investigator: Asmaa Abdallah, PhD, Teaching assistant of physical therapy for surgery, cairo university, egypt

Study record dates

Study Major Dates

• Study Start (Actual): June 30, 2025
• Primary Completion (Actual): January 30, 2026
• Study Completion (Actual): January 30, 2026

Study Registration Dates

• First Submitted: June 26, 2025
• First Submitted That Met QC Criteria: November 19, 2025
• First Posted (Actual): November 20, 2025

Study Record Updates

• Last Update Posted (Actual): June 24, 2026
• Last Update Submitted That Met QC Criteria: June 19, 2026
• Last Verified: June 1, 2026

More Information

Terms related to this study

• Keywords: Graded Motor Imagery; Post Mastectomy
• Other Study ID Numbers: P.T.REC/012/005749

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No