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Falbo KJ, Phelan H, Hackman D, Vogsland R, Rich TL. Graded motor imagery and its phases for individuals with phantom limb pain following amputation: A scoping review. Clin Rehabil 2024; 38:287-304. [PMID: 37849299 PMCID: PMC10860367 DOI: 10.1177/02692155231204185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 09/11/2023] [Indexed: 10/19/2023]
Abstract
OBJECTIVE Three-phase graded motor imagery (limb laterality, explicit motor imagery, and mirror therapy) has been successful in chronic pain populations. However, when applied to phantom limb pain, an amputation-related pain, investigations often use mirror therapy alone. We aimed to explore evidence for graded motor imagery and its phases to treat phantom limb pain. DATA SOURCES A scoping review was conducted following the JBI Manual of Synthesis and Preferred Reporting Items for Systematic Review and Meta-Analyses extension for Scoping Reviews. Thirteen databases, registers, and websites were searched. REVIEW METHODS Published works on any date prior to the search (August 2023) were included that involved one or more graded motor imagery phases for participants ages 18+ with amputation and phantom limb pain. Extracted data included study characteristics, participant demographics, treatment characteristics, and outcomes. RESULTS Sixty-one works were included representing 19 countries. Most were uncontrolled studies (31%). Many participants were male (75%) and had unilateral amputations (90%) of varying levels, causes, and duration. Most works examined one treatment phase (92%), most often mirror therapy (84%). Few works (3%) reported three-phase intervention. Dosing was inconsistent across studies. The most measured outcome was pain intensity (95%). CONCLUSION Despite the success of three-phase graded motor imagery in other pain populations, phantom limb pain research focuses on mirror therapy, largely ignoring other phases. Participant demographics varied, making comparisons difficult. Future work should evaluate graded motor imagery effects and indicators of patient success. The represented countries indicate that graded motor imagery phases are implemented internationally, so future work could have a widespread impact.
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Affiliation(s)
- Kierra Jean Falbo
- Research Department, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, USA
- Rehabilitation Science, University of Minnesota Twin Cities, Minneapolis, MN, USA
| | - Hannah Phelan
- Research Department, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, USA
- Medical School, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Dawn Hackman
- Health Sciences Library, University of Minnesota Twin Cities, Minneapolis, MN, USA
| | - Rebecca Vogsland
- Rehabilitation and Extended Care, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, USA
| | - Tonya L Rich
- Rehabilitation Science, University of Minnesota Twin Cities, Minneapolis, MN, USA
- Rehabilitation and Extended Care, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, USA
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Dee JM, Littenberg B. Regional vs global physical therapy interventions to treat chronic pain in survivors of trauma: a randomized controlled trial. J Man Manip Ther 2023; 31:328-339. [PMID: 36567611 PMCID: PMC10566413 DOI: 10.1080/10669817.2022.2159615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 12/10/2022] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND A history of traumatic life events is associated with chronic pain in later life. Physical therapists utilize a variety of methods to treat pain, however, they have struggled to find effective interventions to improve patient outcomes. OBJECTIVE To compare impairment-based, regional (REGION-PT) physical therapy (PT) to a global (GLOBAL-PT) model consisting of pain neuroscience education, graded motor imagery, and exercise for adults with chronic pain and history of trauma. DESIGN Randomized Controlled Trial. METHODS Adults ≥ 18 years of age with chronic pain and a history of ≥1 trauma identified through the Life Events Checklist received the allocated intervention once a week for six weeks. Treatment effects were assessed using linear mixed models. RESULTS Ninety-eight participants completed the trial. There were no difference in outcomes between groups. There were significant interactions between race and intervention. Both interventions were associated with improvements in pain interference for white participants, but non-white participants experienced improvement only with GLOBAL-PT. Regardless of allocation, participants improved in physical function, six of the PROMIS-29 domains, and in pain interference measures. CONCLUSION Both interventions are reasonable strategies for individuals with chronic pain and a history of trauma.
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Affiliation(s)
- Justine McCuen Dee
- Department of Rehabilitation and Movement Science, University of Vermont
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Limakatso K. Managing acute phantom limb pain with transcutaneous electrical nerve stimulation: a case report. J Med Case Rep 2023; 17:209. [PMID: 37210525 DOI: 10.1186/s13256-023-03915-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 03/28/2023] [Indexed: 05/22/2023] Open
Abstract
INTRODUCTION Phantom limb pain is characterized by painful sensations in the amputated limb. The clinical presentation of acute phantom limb pain may differ from that of patients with chronic phantom limb pain. The variation observed implies that acute phantom limb pain may be driven by peripheral mechanisms, indicating that therapies focused on the peripheral nervous system might be successful in reducing pain. CASE PRESENTATION A 36-year-old African male with acute phantom limb pain in the left lower limb, was treated with transcutaneous electrical nerve stimulation. CONCLUSION The assessment results of the presented case and the evidence on acute phantom limb pain mechanisms contribute to the current body of literature, indicating that acute phantom limb pain presents differently to chronic phantom limb pain. These findings emphasize the importance of testing treatments that target the peripheral mechanisms responsible for phantom limb pain in relevant individuals with acquired amputations.
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Affiliation(s)
- Katleho Limakatso
- Department of Anaesthesia and Perioperative Medicine, Pain Management Unit, Neuroscience Institute, University of Cape Town, Cape Town, South Africa.
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Tan JM, Halford GRJ, Lukin M, Kohler F. Recommendations from the ISPO lower-limb COMPASS: Patient-reported and performance-based outcome measures. Prosthet Orthot Int 2023; 47:13-25. [PMID: 36629556 PMCID: PMC9945573 DOI: 10.1097/pxr.0000000000000197] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 08/01/2022] [Accepted: 09/08/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND Outcome measures (patient-reported and performance-based) are used widely but not uniformly within the clinical setting for individuals with lower-limb absence (LLA). The need for more detailed information by funding bodies, service planners and providers, and researchers requires the systematic and routine use of outcome measures. Currently, there is no consensus on which outcome measure(s) should be used for individuals with LLA. The aim of the International Society of Prosthetics and Orthotics (ISPO) lower-limb Consensus Outcome Measures for Prosthetic and Amputation Services (COMPASS) was to produce a recommended list of outcome measures to be actively promoted for routine use within clinical practice before and after an episode of care. METHODS Between May and June 2021, 46 users, clinicians, researchers, managers, and policymakers working in the field of LLA and prosthetic users met virtually. Consensus participants were first asked to complete an online survey with questions based on the results from a systematic review and the outcomes from an expert panel. A modified Delphi technique was used to determine outcome measures for use in routine clinical practice. This paper discusses the ISPO lower-limb COMPASS process from which recommendations were made. RESULTS The ISPO lower-limb COMPASS resulted in the following 6 recommendations: (1) Amputee Mobility Predictor, Timed Up and Go, Two-Minute Walk Test, Prosthetic Evaluation Questionnaire-Residual Limb Health, Prosthetic Evaluation Questionnaire-Utility, and Trinity Amputation and Prosthesis Experience Scales-Revised, which make up the ISPO lower-limb COMPASS ; (2) Comprehensive High-Level Activity Mobility Predictor and Six-Minute Walk Test are 2 additional outcome measures recommended for higher-activity-level individuals with LLA, which make up the COMPASS+ ; (3) Patient-Specific Function Scale makes up the COMPASS Adjunct ; (4) a generic health-related quality of life outcome measure such as the European Quality of Life-5D-5L or Patient-Reported Outcomes Measurement Information System-29 item can be used to supplement the COMPASS; (5) outcome measures suited to low- and middle-income countries need to be developed with a focus on activities such as sitting cross-legged, kneeling, squatting, and other culturally important mobility-related activities; and (6) translation, validation, and open sharing of translated outcome measures included in the COMPASS, COMPASS+, and COMPASS Adjunct occurs. CONCLUSION The above recommendations represent the current status of knowledge on outcome measures for LLA based on research and international consensus and hence, will change over time. This work has been developed for clinicians and researchers to improve knowledge on outcome measures to guide clinical decision-making and future research initiatives.
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Affiliation(s)
- Jade M. Tan
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
- School of Physiotherapy, Podiatry, Prosthetics and Orthotics, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
| | - Gregory R. J. Halford
- School of Physiotherapy, Podiatry, Prosthetics and Orthotics, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
- International Society of Prosthetics and Orthotics (ISPO), Copenhagen, Denmark
| | - Martina Lukin
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
- School of Physiotherapy, Podiatry, Prosthetics and Orthotics, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
- International Society of Prosthetics and Orthotics (ISPO), Copenhagen, Denmark
- School of Clinical Medicine, Medicine & Health, University of New South Wales, Sydney, Australia
- Clinical Directorate Aged Care and Rehabilitation, South Western Sydney Local Health District, Liverpool, Australia
- Rehabilitation Medicine, Braeside Hospital, Braeside Hospital, HammondCare Health, Sydney, Australia
| | - Friedbert Kohler
- School of Clinical Medicine, Medicine & Health, University of New South Wales, Sydney, Australia
- Clinical Directorate Aged Care and Rehabilitation, South Western Sydney Local Health District, Liverpool, Australia
- Rehabilitation Medicine, Braeside Hospital, Braeside Hospital, HammondCare Health, Sydney, Australia
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Limb Laterality Discrimination, Evoked Sensations and Somatosensory Behavior in Fibromyalgia Syndrome: A Cross-Sectional Study. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12157495] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The main objective of this study was to assess the status of body schema using limb laterality discrimination tasks and pain measurement variables of patients with FMS compared to healthy subjects. The secondary aim was to analyze the relationships between laterality discrimination with respect to somatosensory variables. Thirty female patients with FMS (with a mean age of 52.43 ± 11.82 years) and thirty healthy women (with a mean age of 47.93 ± 5.92 years) were recruited. The main outcome measures were laterality discrimination, referral of evoked sensations, pressure pain threshold and conditioned pain modulation. The main analysis showed that patients with FMS have a longer reaction time for laterality discrimination in hands (hands—20 images, t = 4.044, p < 0.0001, d = 1.04; hands—50 images t = 4.012, p < 0.0001, d = 1.31; feet—20 images t = 2.982, p < 0.01, d = 0.76; feet—50 images, t = 2.159, p < 0.05, d = 0.55). With regard the secondary analysis, patients with FM have higher mechanical hyperalgesia (t = −9.550; p < 0.0001, d = 2.51) and decreased response to conditioned pain modulation compared with healthy subjects (t = 15.519; p < 0.0001, d = 4.17). A positive correlation was found in patients with FMS between greater laterality discrimination ability and better function of conditioned pain modulation (hands r = 0.676, p < 0.0001; feet r = 0.485, p < 0.01). In conclusion, patients with FMS have a longer reaction time and lower accuracy for laterality discrimination, increased mechanical hyperalgesia and decreased conditioned pain modulation compared to healthy subjects. Finally, it seems that there is a positive correlation between greater laterality discrimination ability and better conditioned pain modulation function.
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Limakatso K, Madden VJ, Manie S, Parker R. The effectiveness of graded motor imagery for reducing phantom limb pain in amputees: a randomised controlled trial. Physiotherapy 2020; 109:65-74. [PMID: 31992445 DOI: 10.1016/j.physio.2019.06.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 04/10/2019] [Accepted: 06/24/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To investigate whether graded motor imagery (GMI) is effective for reducing phantom limb pain (PLP) in people who have undergone limb amputations. DESIGN A single-blinded randomised, controlled trial. SETTING Physiotherapy out-patient departments in three secondary level hospitals in Cape Town, South Africa. PARTICIPANTS Twenty-one adults (≥18 years) who had undergone unilateral upper or lower limb amputations and had self-reported PLP persisting beyond three months. INTERVENTIONS A 6-week GMI programme was compared to routine physiotherapy. The study outcomes were evaluated at baseline, 6 weeks, 3 months and 6 months. OUTCOME MEASURES The pain severity scale of the Brief Pain Inventory (BPI) was used to assess the primary outcome - PLP. The pain interference scale of the BPI and the EuroQol EQ-5D-5L were used to assess the secondary outcomes - pain interference with function and health-related quality of life (HRQoL) respectively. RESULTS The participants in the experimental group had significantly greater improvements in pain than the control group at 6 weeks and 6 months. Further, the participants in the experimental group had significantly greater improvements than the control group in pain interference at all follow-up points. There was no between-group difference in HRQoL. CONCLUSION The results of the current study suggest that GMI is better than routine physiotherapy for reducing PLP. Based on the significant reduction in PLP and pain interference within the participants who received GMI, and the ease of application, GMI may be a viable treatment for treating PLP in people who have undergone limb amputations. CLINICAL TRIAL REGISTRATION NUMBER (PACTR201701001979279).
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Affiliation(s)
- Katleho Limakatso
- Pain Management Unit, Department of Anaesthesia and Perioperative Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Victoria J Madden
- Pain Management Unit, Department of Anaesthesia and Perioperative Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; Department of Psychiatry and Mental Health, Faculty of Health Sciences, University of Cape Town, Groote Schuur Hospital, Cape Town, South Africa
| | - Shamila Manie
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Romy Parker
- Pain Management Unit, Department of Anaesthesia and Perioperative Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
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Psychological Factors Associated with Phantom Limb Pain: A Review of Recent Findings. Pain Res Manag 2018; 2018:5080123. [PMID: 30057653 PMCID: PMC6051014 DOI: 10.1155/2018/5080123] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 05/12/2018] [Indexed: 01/21/2023]
Abstract
Phantom limb pain (PLP) is a common phenomenon occurring after the amputation of a limb and can be accompanied by serious suffering. Psychological factors have been shown to play an important role in other types of chronic pain, where they are pivotal in the acquisition and maintenance of pain symptoms. For PLP, however, the interaction between pain and psychological variables is less well documented. In this review, we summarize research on the role of emotional, motivational, cognitive, and perceptual factors in PLP. The reported findings indicate that emotional factors modulate PLP but might be less important compared to other types of chronic pain. Additional factors such as the amount of disability and adjustment to the amputation appear to also play a role. Bidirectional relationships between stress and PLP have been shown quite consistently, and the potential of stress and tension reduction in PLP treatment could be further exploited. Little is known about the role of cognitive variables such as attention or expectation. Catastrophizing seems to aggravate PLP and could be targeted in treatment. Body perception is altered in PLP and poses a potential target for novel mechanistic treatments. More research on psychological factors and their interactions in PLP is needed.
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