Comparison of virtual reality and motor imagery applications in patients with ankle instability

The aim of this study was to compare the effects of virtual reality (VR) and motor imagery (MI) applications added to conventional physiotherapy on pain, muscle strength, functionality, proprioception, dynamic and static balance and patient satisfaction in a rehabilitation program for patients with ankle instability. We also aim to contribute to the understanding of the effect of combined VR and MI and to fill the gap in the literature about the different effects of MI. Thirty patients with ankle instability were randomized into 3 groups; group 1: conventional, group 2: conventional + VR and group 3: conventional + VR + MI. Treatment for each group was continued for 4 weeks, 3 sessions per week. After the dropouts, the study was completed with thirty participants aged 18-60 years. Ankles were assessed before and after treatment using visual analog scale and pressure pain threshold for pain, single leg stance test (SLS) for static balance, star execution test (SET) for dynamic balance, Cumberland Ankle Instability Tool (CAIT) for functionality, manual muscle test (MMT) for muscle strength, inclinometer mobile application for range of motion (ROM) and proprioception, and patient satisfaction with global scoring tool. In conclusion, there was no statistically significant difference (ANOVA) between the groups for all parameters of all nine assessment points (p>.05). Intragroup assessment showed significant improvements in the scores of all groups, but PPT measurements showed a significant difference between the groups only in Group 1 (p<.05). and intragroup CAIT for Group 1 showed a significant difference (p=.005) and ROM showed the highest significant result for Group 3. The effect size result showed that Group 3 had the highest effect size for VAS rest (EB=0.58), SET Mean (13.64±4.27 cm), SET Relevant (8.96±3.40), ROM, MMT and patient satisfaction. On the other hand, VAS activity was shown to be higher in Group 1 (p=.008, EB = 1.60), Proprioception Group 2 (p=.013, EB = -1.07), SLS open eyes Group 1(EB = -1.57) and SLS closed Group 1 (EB = -2.11). By using virtual reality in combination with an MI rehabilitation program, ankle range of motion, discomfort, functionality, proprioception, muscle strength, static and adynamic balance, and patient satisfaction can be improved. All three groups showed a significant improvement, but there was no statistically significant difference between them when final measurements were used. Further research is needed to test the effect of MI on a large number of patients and different genders and to recognize the long-term effect of MI.