# Central Neuromuscular Reactivation Using Digital Mindfulness and Motor Imagery Intervention for Chronic Knee Pain in Patients With Obesity: Prospective, Single-Center Study

## TL;DR

A new app-based therapy using mindfulness and mental visualization significantly improved knee pain and quality of life in obese patients over a month.

## Contribution

This study introduces a novel non-invasive intervention targeting central neuromuscular dysfunction in chronic knee pain patients with obesity.

## Key findings

- Patients showed a 51% improvement in SANE scores and a 56% increase in KOOS scores after the intervention.
- SF-36 scores improved by 66% for physical health and 36% for mental health, with no adverse effects reported.
- Patient satisfaction was high (4.5/5), suggesting strong potential for this non-invasive approach.

## Abstract

Chronic musculoskeletal pain, particularly in patients with obesity, poses significant challenges due to increased pain sensitivity, reduced mobility, and systemic inflammation. Obesity aggravates mechanical constraints on the joints and increases systemic inflammation, exacerbating certain medical conditions and making conventional therapeutic approaches less likely to succeed. Conventional therapies often show limited efficacy, necessitating innovative approaches.

This pilot study evaluated the short-term effectiveness of a mindfulness and motor imagery-based intervention delivered via an app (SAS YUZIT), on the pain, functionality, and quality of life of patients with obesity and chronic knee pain.

A prospective, single-center study was conducted over 1 month by including 30 patients (BMI >30 kg/m2) experiencing chronic knee pain (≥3 months) who did not need surgery. Patients underwent two video-guided motor imagery sessions, focusing on neuromuscular reactivation. Functional scores, including the Single Assessment Numeric Evaluation (SANE) score, Knee Injury and Osteoarthritis Outcome Score (KOOS), and 36-Item Short Form Health Survey (SF-36) score, were assessed before and after intervention. Paired t tests were used to analyze score improvements, with P<.05 deemed significant.

Significant improvements were observed across all parameters. The mean overall SANE score improved by 51% (P<.001). The minimal clinically important difference was therefore approximately 6.7 points. The observed mean improvement (25 points) exceeded this threshold by more than threefold, indicating a clinically meaningful improvement in functional status. The mean (SD) KOOS score increased by 56% (P<.001) from 40.89 (16.7) to 63.79 (14.6). The mean (SD) SF-36 scores showed substantial enhancements in both physical (from 39.7 [20.8] to 65.9 [18.8]; +66%; P<.001) and mental components (from 47.2 [23.1] to 64 [21]; +36%; P<.001). Patient satisfaction with this method was rated 4.5/5, and no adverse effects were reported.

Video-guided motor imagery demonstrated significant efficacy in reducing pain and improving the functionality and quality of life of patients with obesity and chronic knee pain. By targeting central neuromuscular circuits through guided visualization exercises, this non-invasive intervention addresses central activation dysfunction, a proposed novel concept in neuromuscular disorders that originates from hypotheses derived from clinical observations. This interesting concept requires further exploration to ensure its neurophysiological validation through future studies with larger sample sizes, control groups, and long-term follow-ups, all of which could explore CAD as a therapeutic target.