Cross-cultural adaptation, reliability and validity of the Greek version of the Movement Imagery Questionnaire-3 (MIQ-3)

Introduction

Motor imagery is a cognitive process that may play an important role during the planning and execution of movement. During motor imagery a person imagines performing a specific movement without actually executing it [1]. It is widely used for patients’ rehabilitation [2]. Motor imagery shows encouraging results during the treatment of both musculoskeletal and neurological disorders. Also it is frequently used to enable motor relearning, promote motor rehabilitation and improve performance in sport [3].

Imagery subscales are kinesthetic imagery (KI) and visual imagery (VI). Kinesthetic imagery (KI) requires the participants to indicate the “feeling’’ of the movement without actually executing it. Visual imagery consists of internal visual imagery (IVI) that requires participants to imagine a movement through their own eyes and external visual imagery (EVI) where individuals must mentally simulate the movement as spectators (i.e., by viewing themselves from another person’s perspective) [4].

There is considerable evidence that during MI process different cortical and subcortical areas are activated [5, 6]. For instance, an image using different visual perspectives can involve different parts of the cortex. The right inferior parietal, precuneus (posteromedial portion of the parietal lobe), and somatosensory cortices have been found to distinguish self-produced actions from those generated by others [6]. KI yields more activity in motor-associated structures and the inferior parietal lobule [1]. White and Hardy [7] observed that IVI was found to be beneficial for movement abilities that require programming. On the contrary they stated that EVI may be associated with body coordination movements.

The existence of valid and reliable questionnaires to assess MI is considered necessary. The revised version of the Movement Imagery Questionnaire [8] is one of the most commonly used questionnaires to evaluate the ability of motor imagery. A new edition of MIQ-R is the Movement Imagery Questionnaire-3 (MIQ-3) [3] that additionally assesses the ability to mentally “see” and “feel” four simple movements: a knee lift, jump, arm movement, and waist bend. This last modified version (MIQ-3) appraises all different types of imagery: kinesthetic, internal and external VI. Participants mentally imagine each movement before rating how easy or difficult it is to ‘’see’’/’’feel’’ this movement.

MIQ-3 is a valuable instrument that has been used widely. In particular, it has been cross-culturally adapted and validated into French, Persian, Polish, Portuguese, Slovenian, Spanish and Turkish [ 9, 10, 11, 12, 13, 14, 15 ] overall demonstrating good psychometric properties. Additionally, it is a brief scale consisting of 12 items and is easy to administer. Due to the lack of a motor imagery questionnaire translated in Greek, this study is deemed as essential. The aim of this study was the translation and cross cultural adaptation of the MIQ-3 in a Greek population of healthy participants.

Methods

Results

Discussion

The present study aimed to cross-culturally adapt and examine the measuring properties of the Greek version of MIQ-3. A five-stage approach was followed, according to set principles of the cross-cultural adaptation process, including construct validity items deemed appropriate in previous adaptations of the scale in several different languages. Participants found the scale and the concepts examined interesting and easy to perform and rate. This study’s results were generally similar to those of previous validations of the scale [3, 9, 10, 14, 15].

Specifically, the internal consistency showed similar scores to the original English validation of the questionnaire. Similarly, the absolute reliability, expressed by the SEM and examined in parallel with the ICC showed acceptable scores. Indeed, the SEMs in our study were smaller than those presented in a recently published cross-cultural adaptation [15], but higher than those presented in another [13]. On the contrary, the relative reliability of the questionnaire, as expressed by the ICC measure, did not show satisfactory results. The ICC relative reliability indices of MIQ-3 appear to be satisfactory in the Spanish, Slovenian, and Turkish versions compared to the present one. The ICC values in these studies were between 0.60 and 0.92 [10, 13, 15]. However, it has to be noted that low ICC can be found even when trial-to-trial variability is low if the between-subjects’ variability is low. In this case, it is difficult to differentiate between subjects; however, the absolute measurement error, expressed by the SEM, is small [22].

Furthermore, the construct validity of the scale was assessed. The factor analysis of the questionnaire was examined with EFA. Other studies examined only confirmatory factor analysis [9, 10, 15] or both analyses [3, 14]. The PAF confirmed the three-factor model [3]. Τhe Slovenian validation confirmed a two-factor model [13], which contradicts with the results of the rest of the MIQ-3 validations [3, 9, 10, 12, 14, 15]. Internal visual imagery and kinesthetic imagery may occur simultaneously. Callow et al. [25] suggested that this combination of the two types of MI might show better results for exercising imagery.

The results of the study did not show a difference in the scores between the genders. Men and women seem to have similar scores for internal and external visual imagery and kinesthetic imagery, confirming the results of previous research [3, 13, 26]. Mendes et al. [12] suggested that men had better scores in kinesthetic imagery than women. Monsma et al. [27] reported that women were found to have better scores in visual imagery than men. However, in a recent study [28] confirmed that MIQ-3 shows gender invariance. In our study, the between-gender differences were insignificant, thus the questionnaire can be used by both men and women. This invariance is important for further research of motor imagery.

The possible influence of athletic involvement has already been investigated in the original version of MIQ-3 [3], assessing whether professional athletes demonstrate better scores in motor imagery compared with less experienced or participants with no athletic involvement. The results of the present study confirm the findings of several previous studies [3, 9, 13]. The differences between professional athletes and no athletes were not significant. In particular, professional athletes had better scores only in internal motor imagery in the Polish version of MIQ-3 [9]. The sample of the professional athletes was small compared to other levels of expertise, and the simplicity of the movements (i.e., raise your knee, move your hand in front of your body) are two factors possibly explaining the results of the present study. The present questionnaire can successfully evaluate motor imagery in every level of practice.

The intensity of physical activity was also examined between the motor imagery types. The medium physical activity athletes showed higher scores in all three types of MI. There were no significant differences in the score for individuals with high, medium, or low physical activity or no athletes. On the contrary, Lorant and Nicolas, and Robin et al. [14, 17] reported that high physical activity athletes had significantly higher scores than the medium, and the low physical activity athletes, or no athletes. The above studies indicate that the increase in the intensity of physical activity might facilitate the use of motor imagery. Hardy and Callow [29] reported that kinesthetic ability could be improved as athletes get more experienced. The use of kinesthetic motor imagery can be improved by increasing the frequency and the time of practice.

Limitations and suggestions for future research

The present study had a few limitations. The study sample included young healthy participants which limits the results’ generalization. Another limitation is that the participants’ number is disproportionate in each category of the level of expertise, with a lot fewer professional athletes than the non-athletes. Lastly, completing the questionnaire through the MS-Teams platform could have affected its measurement properties. Future research should be conducted to evaluate the concurrent and discriminant validity of the questionnaire.

Conclusions

The Greek version of MIQ-3 is a valid and reliable questionnaire that can be used to assess an individual’s motor imagery ability. Further research is required to examine if the questionnaire can differentiate between participants of different intensities and levels of activity.