J Bodyw Mov Ther. 2026 Jul;47:354-360. doi: 10.1016/j.jbmt.2026.04.021. Epub 2026 Apr 27.

ABSTRACT

BACKGROUND: Patellofemoral pain (PFP) has been associated with altered central processing and implicit motor imagery, as assessed using left-right judgment tasks. However, the feasibility of assessing implicit motor imagery performance in individuals with bilateral PFP and high kinesiophobia, particularly with a dry needling intervention, has not been established.

METHODS: This feasibility pilot evaluated the practicality and safety of administering an implicit motor imagery assessment before and after dry needling. Ten participants with chronic bilateral PFP and elevated kinesiophobia completed the NOI Recognise Knee left-right judgment task (200 images across four difficulty levels) at baseline and immediately following intervention. Feasibility outcomes included recruitment, protocol completion, and adverse events. Accuracy (%) and response time (seconds) were summarized descriptively to characterize distribution and variability. A design-informing sample size estimation was conducted to support planning of future randomized controlled trials.

RESULTS: All participants (mean age 27.5 years) completed the protocol without attrition. No serious adverse events occurred, and minor needling-related symptoms were transient. Implicit motor imagery performance demonstrated substantial inter-individual variability across difficulty levels and time points. The Basic difficulty level showed lower accuracy and greater variability relative to other levels, suggesting increased task demand in the absence of contextual cues. Visual inspection of individual trajectories revealed heterogeneous patterns before and after intervention. Sample size estimation indicated that approximately 128 participants (64 per group) would be required to evaluate intervention effects in a future controlled trial.

CONCLUSION: Assessing implicit motor imagery performance before and after dry needling in individuals with bilateral PFP and high kinesiophobia is feasible and safe. Outcome variability supports the need for adequately powered, controlled trials and highlights the importance of feasibility assessment prior to efficacy testing.

PMID:42264814 | DOI:10.1016/j.jbmt.2026.04.021