Effectiveness of Mindfulness-Based Cognitive Therapy and Graded Motor Imagery on Kinesiophobia in Individuals with Median Nerve Injury: A Randomized Controlled Trial

Purpose. Median nerve injury is often associated with pain and functional impairment, which can contribute to kinesiophobia and limit upper limb recovery. Such psychological factors causing fear of movement can substantially delay recovery. This study aimed to compare the effectiveness of Mindfulness-Based Cognitive Therapy (MBCT) and Graded Motor Imagery (GMI) on kinesiophobia in individuals with median nerve injury. Materials & Methods. This comparative study was carried out in a private clinical rehabilitation setting. Thirty participants with median nerve injury were randomly allocated to either MBCT plus conventional physiotherapy or GMI plus conventional physiotherapy. Both interventions were administered three times per week for 6 weeks, with each session lasting 90 minutes. The MBCT intervention comprised mindfulness-based cognitive sessions, while the GMI intervention comprised laterality training, motor imagery and mirror therapy. The pre-and-post interventional outcomes were assessed using the Tampa Scale for Kinesiophobia-11 (TSK-11) and Quick Disabilities of Arm, Shoulder and Hand (QuickDASH). Results. At post-intervention, both groups demonstrated statistically and clinically meaningful improvements in kinesiophobia and upper limb function (p<0.001). Repeated-measures ANOVA revealed significant time × group interaction effects for TSK-11 (F=18.193, p<0.001, partial η²=0.394) and QuickDASH (F=31.943, p<0.001, partial η²=0.533), indicating greater improvements in the Graded Motor Imagery group compared to the Mindfulness-Based Cognitive Therapy group. Conclusions. Both Mindfulness-Based Cognitive Therapy and Graded Motor Imagery combined with conventional physiotherapy were effective in reducing kinesiophobia and improving functional outcomes. However, Graded Motor Imagery demonstrated greater improvements.