{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T15:58:48Z","timestamp":1791302328858,"version":"4.1.0"},"reference-count":61,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T00:00:00Z","timestamp":1791244800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"\n Background<\/jats:title>\n Post-stroke pain is a common and intractable complication that hinders neurorehabilitation progress. Motor Guided Imagery (MGI), an emerging rehabilitation technique based on brain-computer interaction principles, has shown potential in relieving post-stroke pain, yet high-quality evidence on its multi-dimensional efficacy remains insufficient. This study aimed to systematically evaluate the effects of MGI on pain, sensorimotor function, sleep quality, life status, and psychological mood in stroke patients using a three-level meta-analysis.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n This study aimed to quantitatively assess the therapeutic effects of Motor Guided Imagery for stroke-related pain and explore potential intervention moderators using a three-level meta-analysis framework.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n Eight Chinese and English databases were searched from inception to June 29, 2025, to collect randomized controlled trials (RCTs) of MGI for stroke patients with pain. A three-level random-effects model was adopted to pool Hedges\u2019\n g<\/jats:italic>\n effect sizes, accompanied by heterogeneity testing, moderator analysis, influence analysis, and publication bias assessment. Influence-based outlier detection was implemented; analyses retaining all effect-size observations were treated as the primary main analysis, while outlier-removed analyses were reported only as supplementary sensitivity checks.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Motor-guided imagery training significantly relieved pain (\n g<\/jats:italic>\n \u202f=\u202f\u22120.524, 95% CI -0.779 to \u22120.269,\n p<\/jats:italic>\n \u202f=\u202f0.0006; negative Hedges\u2019 g indicates clinical improvement for this outcome) and improved sleep quality (\n g<\/jats:italic>\n \u202f=\u202f\u22121.658, 95% CI -2.115 to \u22121.201,\n p<\/jats:italic>\n \u202f&lt;\u202f0.001; negative Hedges\u2019 g indicates clinical improvement for this outcome) in stroke patients. Meanwhile, it significantly enhanced motor function (\n g<\/jats:italic>\n \u202f=\u202f1.395, 95% CI 0.963 to 1.826,\n p<\/jats:italic>\n \u202f&lt;\u202f0.001), life status (\n g<\/jats:italic>\n \u202f=\u202f1.757, 95% CI 0.966 to 2.549,\n p<\/jats:italic>\n \u202f=\u202f0.0012), and psychological-emotional status (\n g<\/jats:italic>\n \u202f=\u202f1.729, 95% CI 1.045 to 2.413,\n p<\/jats:italic>\n \u202f=\u202f0.0002); positive Hedges\u2019 g indicates clinical improvement for the latter three outcomes. Moderator analysis indicated that acute-phase intervention (\u22644\u202fweeks) and high-frequency regimens (&gt;5 sessions\/week) tended to produce better analgesic effects, while age, gender, single-session duration, and pain location had no significant moderating effects.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n MGI may produce beneficial rehabilitation effects that can alleviate post-stroke pain and synergistically improve motor function, sleep, daily-living ability, and psychological state of stroke patients. Exploratory subgroup trends indicated potentially larger effects for early implementation within the acute phase and high-frequency short-duration regimens. However, these observations should be interpreted as hypothesis-generating clues given non-significant overall moderator tests. Further high-quality research is required to confirm these findings.<\/jats:p>\n <\/jats:sec>\n \n Registration<\/jats:title>\n The systematic review protocol was retrospectively registered with PROSPERO under registration ID CRD420261278812, after literature search and full-text screening had been completed.<\/jats:p>\n <\/jats:sec>\n \n Systematic review registration<\/jats:title>\n \n https:\/\/www.crd.york.ac.uk\/PROSPERO\/view\/CRD420261278812<\/jats:ext-link>\n ; identifier: CRD420261278812\n <\/jats:p>\n <\/jats:sec>","DOI":"10.3389\/fneur.2026.1920523","type":"journal-article","created":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T15:33:46Z","timestamp":1791300826000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Impact of motor guided imagery therapy on stroke patients with pain symptoms: a three-level meta-analysis and systematic review of randomized controlled trials"],"prefix":"10.3389","volume":"17","author":[{"given":"Xinmo","family":"Li","sequence":"first","affiliation":[{"name":"Institute of Physical Education and Training, Capital University of Physical Education and Sports","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hong","family":"Ni","sequence":"additional","affiliation":[{"name":"School of Recreation and Community Sport, Capital University of Physical Education and Sports","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guangze","family":"Cui","sequence":"additional","affiliation":[{"name":"The High School Affiliated to Beijing Jiaotong University, Beijing, China, 3Shenyang Normal University","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chen","family":"Wei","sequence":"additional","affiliation":[{"name":"College of Sports Science, Shenyang Normal University","place":["Shenyang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yongguo","family":"Zhu","sequence":"additional","affiliation":[{"name":"School of Ice\u2011Snow Sports, Capital University of Physical Education and Sports","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,10,6]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"1645","DOI":"10.1213\/ane.0b013e31819d644c","article-title":"Central poststroke pain: a review of pathophysiology and treatment","volume":"108","author":"Kumar","year":"2009","journal-title":"Anesth Analg"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"190","DOI":"10.1159\/000375397","article-title":"Post stroke pain: identification, assessment, and therapy","volume":"39","author":"Harrison","year":"2015","journal-title":"Cerebrovasc Dis"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"728","DOI":"10.1002\/ana.410360507","article-title":"The shoulder\u2013hand syndrome after stroke: a prospective clinical trial","volume":"36","author":"Braus","year":"1994","journal-title":"Annal Neurol"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"276","DOI":"10.1191\/0269215502cr491oa","article-title":"Shoulder pain after stroke: a review of the evidence base to inform the development of an integrated care pathway","volume":"16","author":"Turner-Stokes","year":"2002","journal-title":"Clin Rehabil"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"386","DOI":"10.1016\/j.jphysparis.2006.03.012","article-title":"Motor imagery","volume":"99","author":"Lotze","year":"2006","journal-title":"J Physiol-Paris"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"942","DOI":"10.2522\/ptj.20060331","article-title":"Motor imagery in physical therapist practice","volume":"87","author":"Dickstein","year":"2007","journal-title":"Phys Ther"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"2129","DOI":"10.1212\/01.wnl.0000249112.56935.32","article-title":"Graded motor imagery for pathologic pain: a randomized controlled trial","volume":"67","author":"Moseley","year":"2006","journal-title":"Neurology"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"985","DOI":"10.3761\/j.issn.0254\u20111769.2019.07.005","article-title":"Application of motor-guided imagery training in patients with stroke","volume":"54","author":"Chen","year":"2019","journal-title":"Chin J Nurs"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"390","DOI":"10.3389\/fnhum.2013.00390","article-title":"The effects of mental practice in neurological rehabilitation; 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