Motor Imagery to Facilitate Sensorimotor Re-Learning (MOTIFS): Integrating Dynamic Motor Imagery in Current Treatment of Knee Injury

Traumatic knee injury is common in physical activity that includes jumping and cutting movements, and most commonly include anterior cruciate ligament (ACL) or meniscus injuries. Surgical or non-surgical intervention strategies may be chosen, but treatment will include a physical-therapist led physical training program. The aim of this training is to strengthen and stabilize the knee. Despite receiving best-practice treatment, many are unable to return to their pre-injury activity level. Recent research has suggested that this may be explained, in part, by psychological factors such as fear of re-injury or lack of confidence. In addition to physical treatment, guidelines include recommendations to address psychological factors. The detail of how this can be done is lacking, and the extent to which psychological variables are adequately addressed is questionable. In response to this gap, we have developed the novel Motor Imagery to Facilitate Sensorimotor Re-Learning (MOTIFS) model, which integrates psychological training into physical rehabilitation protocols using a dynamic motor imagery intervention. MOTIFS increases realism and relevance while simultaneously physically and psychologically simulating activity-specific and individualized rehabilitation exercises. The aim of this thesis is therefore to develop and explore the efficacy of the MOTIFS model in physically and psychologically preparing knee-injured people for return to activity compared to care-as-usual rehabilitation. The primary hypothesis of this thesis is that the MOTIFS model will provide greater effects on patient-relevant outcomes and muscle function than current programs. In a first step, the effect of MOTIFS model on enjoyment and other self-reported outcomes was evaluated in a cross-over study (Paper I) in which uninjured people underwent training according to both MOTIFS and care-as-usual training protocols. Next, a protocol detailing an ongoing randomized controlled trial (Paper II) which wil