Effectiveness of remote graded motor imagery therapy for patients with central sensitisation low back pain: study protocol for a randomised controlled trial.

introductionChronic low back pain (CLBP) is a prevalent global condition that significantly impairs quality of life, reduces work productivity and imposes substantial healthcare burdens. Approximately 70% of adults worldwide experience at least one episode of low back pain during their lifetime. Central sensitisation, a common complexity of CLBP, involves heightened responsiveness of the central nervous system, resulting in amplified neural signalling and increased pain sensitivity. This phenomenon suggests that pain in CLBP extends beyond purely biomedical origins, involving multiple factors such as neural adaptation. Graded Motor Imagery (GMI) is a progressive, exercise-based therapeutic approach designed to retrain the brain's representation of the body and has shown promise in managing pain associated with central sensitisation. METHODS AND ANALYSIS: This randomised controlled trial aims to assess the efficacy of remote GMI therapy compared with conventional in-clinic therapy in CLBP patients exhibiting pain sensitisation. Adults aged 20-50 years with persistent low back pain for at least 6 months will be included. Exclusion criteria comprise significant spinal pathology, recent spinal surgery, severe mental disorders, other major chronic pain conditions, high baseline pain levels (Visual Analogue Scale, VAS >7), neurological motor disorders and pregnancy. Eligible participants will be randomised into either an online therapy group or a control group. The online therapy group will engage in GMI exercises using the 'Recognise' app, encompassing tasks such as left/right discrimination, explicit motor imagery and mirror therapy, performed twice daily for 10 min each. The control group will participate in equivalent exercises supervised by a physical therapist, employing physical aids for cognitive tasks and mirror therapy. Both groups will undergo an intensive 6-week therapy phase followed by a 6-month maintenance phase involving weekly sessions to reinforce progress and prevent relapse. Primary outcomes, including pain intensity (VAS) and functional disability (Oswestry Disability Index), alongside secondary measures of pain sensitivity and quality of life, will be assessed at baseline and at 3-month and 6-month follow-ups. ETHICS AND DISSEMINATION: The study protocol has been approved by the Shanghai University of Sport Scientific Research Ethics Committee. Written informed consent will be obtained from all participants. Study results will be disseminated through publications in international peer-reviewed journals and presentations at academic conferences. TRIAL REGISTRATION NUMBER: ChiCTR2400084205.