Feasibility of a traditional and teletreatment approach to mirror therapy in patients with phantom limb pain: a process evaluation performed alongside a randomized controlled trial

Objective:To evaluate the delivery, acceptance and experiences regarding a traditional and teletreatment approach to mirror therapy as delivered in a randomized controlled trial.Design:Mixed methods, prospective study.Setting:Rehabilitation centres, hospital and private practices.Subjects:Adult patients with phantom pain following lower limb amputation and their treating physical and occupational therapists.Interventions:All patients received 4 weeks of traditional mirror therapy ( n = 51), followed by 6 weeks of teletreatment ( n = 26) or 6 weeks of self-delivered mirror therapy ( n = 25).Main measures:Patient files, therapist logs, log files teletreatment, acceptance questionnaire and interviews with patients and their therapists.Results:In all, 51 patients and 10 therapists participated in the process evaluation. Only 16 patients (31%) received traditional mirror therapy according to the clinical framework during the first 4 weeks. Between weeks 5 and 10, the teletreatment was used by 14 patients (56%) with sufficient dose. Teletreatment usage decreased from a median number of 31 (weeks 5–10) to 19 sessions (weeks 11–24). Satisfactory teletreatment user acceptance rates were found with patients demonstrating higher scores (e.g. regarding the usefulness to control pain) than therapists. Potential barriers for implementation of the teletreatment perceived by patients and therapists were related to insufficient training and support as well as the frequency of technical problems.Conclusion:Traditional mirror therapy and the teletreatment were not delivered as intended in the majority of patients. Implementation of the teletreatment in daily routines was challenging, and more research is needed to evaluate user characteristics that influence adherence and how technology features can be optimized to develop tailored implementation strategies.

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Mirror Therapy and Transcutaneous Electrical Nerve Stimulation for Management of Phantom Limb Pain in Amputees - A Single Blinded Randomized Controlled Trial

Physiotherapy Research International ◽

10.1002/pri.1626 ◽

2015 ◽

Vol 21 (2) ◽

pp. 109-115 ◽

Cited By ~ 25

Author(s):

Merlyn Tilak ◽

Serin Anna Isaac ◽

Jebaraj Fletcher ◽

Lenny Thinagaran Vasanthan ◽

Rajalakshmi Sankaran Subbaiah ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Nerve Stimulation ◽

Transcutaneous Electrical Nerve Stimulation ◽

Controlled Trial ◽

Phantom Limb Pain ◽

Phantom Limb ◽

Mirror Therapy ◽

Limb Pain ◽

Electrical Nerve Stimulation ◽

Randomized Controlled

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Traditional and augmented reality mirror therapy for patients with chronic phantom limb pain (PACT study): results of a three-group, multicentre single-blind randomized controlled trial

Clinical Rehabilitation ◽

10.1177/0269215518785948 ◽

2018 ◽

Vol 32 (12) ◽

pp. 1591-1608 ◽

Cited By ~ 10

Author(s):

Andreas Rothgangel ◽

Susy Braun ◽

Bjorn Winkens ◽

Anna Beurskens ◽

Rob Smeets

Keyword(s):

Randomized Controlled Trial ◽

Augmented Reality ◽

Controlled Trial ◽

Phantom Limb Pain ◽

Phantom Limb ◽

Mirror Therapy ◽

Limb Pain ◽

Randomized Controlled ◽

Study Results ◽

Patient Reported

Objective: To compare the effects of traditional mirror therapy (MT), a patient-centred teletreatment (PACT) and sensomotor exercises without a mirror on phantom limb pain (PLP). Design: Three-arm multicentre randomized controlled trial. Setting: Rehabilitation centres, hospital and private practices. Subjects: Adult patients with unilateral lower limb amputation and average PLP intensity of at least 3 on the 0–10 Numeric Rating Scale (NRS). Interventions: Subjects randomly received either four weeks of traditional MT followed by a teletreatment using augmented reality MT, traditional MT followed by self-delivered MT or sensomotor exercises of the intact limb without a mirror followed by self-delivered exercises. Main measures: Intensity, frequency and duration of PLP and patient-reported outcomes assessing limitations in daily life at baseline, 4 weeks, 10 weeks and 6 months. Results: In total, 75 patients received traditional MT ( n = 25), teletreatment ( n = 26) or sensomotor exercises ( n = 24). Mean (SD) age was 61.1 (14.2) years and mean (SD) pain intensity was 5.7 (2.1) on the NRS. Effects of MT at four weeks on PLP were not significant. MT significantly reduced the duration of PLP at six months compared to the teletreatment ( P = 0.050) and control group ( P = 0.019). Subgroup analyses suggested significant effects on PLP in women, patients with telescoping and patients with a motor component in PLP. The teletreatment had no additional effects compared to self-delivered MT at 10 weeks and 6 months. Conclusion: Traditional MT over four weeks was not more effective than sensomotor exercises without a mirror in reducing PLP, although significant effects were suggested in some subgroups.

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