Perceptions of phantom limb pain in lower limb amputees and its effect on quality of life: a qualitative study

Background: Quality of life (QoL) is increasingly being recognized as an important outcome for rehabilitation programs, and has mainly been used to compare the efficacy of interventions or to compare amputees with other diseased populations. There is relatively a limited number of studies primarily focusing on analyzing the multitude of factors influencing QoL in amputees.Objectives: To identify important background and amputation related factors which affect quality of life (QoL) in lower limb amputees, and to compare QoL profile of amputees’ to that of general population.Study design: Cross-sectional.Methods: Lower limb amputees 18 years and above from a rehabilitation centre, a limb-fitting centre and four limb-fitting camps were interviewed ( n = 605). Structured questionnaires included patient background and amputation characteristics, and the MOS short-form health survey (SF-36) for assessing QoL. The SF-36 was administered to a general adult population using purposive sampling ( n = 184).Results: SF-36 PCS and MCS scores were found to be significantly lower for amputees when compared to those for the general population. In this study, employment status, use of an assistive device, use of a prosthesis, comorbidities, phantom-limb pain and residual stump pain were found to predict both PCS and MCS scores significantly, and explained 47.8% and 29.7% of variance respectively. Age and time since amputation accounted for an additional 3% of variance in PCS scores.Conclusions: The abovementioned factors should be addressed in order to ensure holistic reintegration and participation, and to enable the amputees to regain or maintain QoL. Prospective longitudinal studies are recommended to systematically study the change in QoL over time and to assess its determinants.Clinical relevanceProper appraisal of abovementioned factors in the rehabilitation programme would assist in establishing a treatment protocol, which would adequately address QoL in amputees.

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Comparison of Body Positions in Virtual Reality Mirror Box Therapy for Treatment of Phantom Limb Pain in Lower Limb Amputees

Proceedings of the Virtual Reality International Conference - Laval Virtual 2017 on - VRIC '17 ◽

10.1145/3110292.3110307 ◽

2017 ◽

Cited By ~ 1

Author(s):

Ronni Nielsen ◽

Bartal Henriksen ◽

Martin Kraus ◽

Bo Geng

Keyword(s):

Virtual Reality ◽

Lower Limb ◽

Phantom Limb Pain ◽

Phantom Limb ◽

Limb Pain ◽

Mirror Box ◽

Lower Limb Amputees

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Characterisation of Phantom Limb Pain in Traumatic Lower-Limb Amputees

Pain Research and Management ◽

10.1155/2021/2706731 ◽

2021 ◽

Vol 2021 ◽

pp. 1-7

Author(s):

André Tadeu Sugawara ◽

Marcel Simis ◽

Felipe Fregni ◽

Linamara Rizzo Battistella

Keyword(s):

Lower Limb ◽

Phantom Limb Pain ◽

Cross Sectional Study ◽

Phantom Limb ◽

Limb Amputation ◽

Limb Pain ◽

Cross Sectional ◽

Proper Diagnosis ◽

Pain Descriptors ◽

Lower Limb Amputees

Introduction. There is no diagnosis for phantom limb pain (PLP), and its investigation is based on anamnesis, which is subject to several biases. Therefore, it is important to describe and standardize the diagnostic methodology for PLP. Objective. To characterise PLP and, secondarily, to determine predictors for its diagnosis. Methodology. This is a cross-sectional study involving patients with unilateral traumatic lower-limb amputation aged over 18 years. Those with clinical decompensation or evidence of disease, trauma, or surgery in the central or peripheral nervous system were excluded. Sociodemographic and rehabilitative data were collected; PLP was characterised using the visual analogue scale (VAS), pain descriptors, and weekly frequency. Results. A total of 55 eligible patients participated in the study; most were male, young, above-knee amputees in the preprosthetic phase of the rehabilitation. The median PLP VAS was 60 (50–79.3) mm characterised by 13 (6–20) different descriptors in the same patient, which coexist, alternate, and add up to a frequency of 3.94 (2.5–4.38) times per week. The most frequent descriptor was movement of the phantom limb (70.91%). Tingling, numbness, flushing, itchiness, spasm, tremor, and throbbing are statistically significant PLP descriptor numbers per patient predicted by above-knee amputation, prosthetic phase, higher education level, and greater PLP intensity by VAS ( p < 0.05 ). Conclusion. PLP is not a single symptom, but a set with different sensations and perceptions that need directed and guided anamnesis for proper diagnosis.

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Phantom Limb: A Phenomenological Study

The British Journal of Psychiatry ◽

10.1192/bjp.141.1.54 ◽

1982 ◽

Vol 141 (1) ◽

pp. 54-58 ◽

Cited By ~ 46

Author(s):

G. D. Shukla ◽

S. C. Sahu ◽

R. P. Tripathi ◽

D. K. Gupta

Keyword(s):

Upper Limb ◽

Lower Limb ◽

Phenomenological Study ◽

Phantom Limb Pain ◽

Phantom Limb ◽

Limb Pain ◽

Post Operative Period ◽

The Right ◽

Lower Limb Amputees

SummaryPhantom limb phenomena during the post-operative period were studied in 72 amputees. All were right handed. Phantom limb was present in 86.1 per cent of the cases, significantly more commonly following amputation of the right arm. Nearly half of the phantoms developed within the first 24 hours and another quarter in the next 24 hours, appearing earlier in lower limb amputees. Movements in the phantom were felt by three-quarters of the cases, an incidence unaffected by site or side of amputation. Telescopy was present in nearly two-thirds and phantom limb pain in over two-thirds, significantly more commonly in the upper limb amputees but uninfluenced by the side of amputation. Thirty-one of the patients dreamed that their limbs were intact.

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Effects of phantom exercises on pain, mobility, and quality of life among lower limb amputees; a randomized controlled trial

BMC Neurology ◽

10.1186/s12883-021-02441-z ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Anna Zaheer ◽

Arshad Nawaz Malik ◽

Tahir Masood ◽

Sahar Fatima

Keyword(s):

Quality Of Life ◽

Lower Limb ◽

Controlled Trial ◽

Phantom Limb ◽

Mirror Therapy ◽

Randomized Controlled ◽

Sf 36 ◽

Experimental Group ◽

Lower Limb Amputees

Abstract Background The objective of the current study is to evaluate the effects of phantom exercises on phantom limb pain, mobility status, and quality of life in lower limb amputees treated with mirror therapy and routine physiotherapy. Methods It is a randomized controlled trial in which 24 unilateral lower limb amputees (above and below the knee) were randomly assigned to two equal groups i.e., control group (mirror therapy and conventional physical therapy) and experimental group in which, phantom exercises were given, additionally. Physical therapy included conventional therapeutic exercises while phantom exercises include imagining the movement of the phantom limb and attempting to execute these movements Data were collected at baseline, after 2 and 4 weeks of intervention using VAS (pain), AMP (mobility) and RAND SF-36 Version 1.0 (QOL) questionnaires. All statistical analyses were done with IBM SPSS 25.0 with 95% CI. Results Twenty-four amputees (17 males and 7 females) participated in this trial. The Mean age of the participants in experimental and control groups was 45.3 ± 11.1 years and 40.5 ± 12.5 years respectively. After the intervention, the pain (VAS score) was significantly lower in the experimental group (p = 0.003). Similarly, the experimental group demonstrated a significantly better score in the “bodily pain” domain of SF-36 (p = 0.012). Both groups significantly (p < 0.05) improved in other domains of SF-36 and ambulatory potential with no significant (p > 0.05) between-group differences. Conclusions The Addition of phantom exercises resulted in significantly better pain management in lower limb amputees treated with mirror therapy and routine physiotherapy. Trial registration This study is registered in the U.S National Library of Medicine. The clinical trials registration number for this study is NCT04285138 (ClinicalTrials.gov Identifier) (Date: 26/02/2020).

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Phantom motor execution as a treatment for phantom limb pain: protocol of an international, double-blind, randomised controlled clinical trial

BMJ Open ◽

10.1136/bmjopen-2017-021039 ◽

2018 ◽

Vol 8 (7) ◽

pp. e021039 ◽

Cited By ~ 4

Author(s):

Eva Lendaro ◽

Liselotte Hermansson ◽

Helena Burger ◽

Corry K Van der Sluis ◽

Brian E McGuire ◽

...

Keyword(s):

Quality Of Life ◽

Phantom Limb Pain ◽

Phantom Limb ◽

Controlled Clinical Trial ◽

Motor Execution ◽

Limb Pain ◽

Double Blind ◽

Randomised Controlled Clinical Trial ◽

Randomised Controlled

IntroductionPhantom limb pain (PLP) is a chronic condition that can greatly diminish quality of life. Control over the phantom limb and exercise of such control have been hypothesised to reverse maladaptive brain changes correlated to PLP. Preliminary investigations have shown that decoding motor volition using myoelectric pattern recognition, while providing real-time feedback via virtual and augmented reality (VR-AR), facilitates phantom motor execution (PME) and reduces PLP. Here we present the study protocol for an international (seven countries), multicentre (nine clinics), double-blind, randomised controlled clinical trial to assess the effectiveness of PME in alleviating PLP.Methods and analysisSixty-seven subjects suffering from PLP in upper or lower limbs are randomly assigned to PME or phantom motor imagery (PMI) interventions. Subjects allocated to either treatment receive 15 interventions and are exposed to the same VR-AR environments using the same device. The only difference between interventions is whether phantom movements are actually performed (PME) or just imagined (PMI). Complete evaluations are conducted at baseline and at intervention completion, as well as 1, 3 and 6 months later using an intention-to-treat (ITT) approach. Changes in PLP measured using the Pain Rating Index between the first and last session are the primary measure of efficacy. Secondary outcomes include: frequency, duration, quality of pain, intrusion of pain in activities of daily living and sleep, disability associated to pain, pain self-efficacy, frequency of depressed mood, presence of catastrophising thinking, health-related quality of life and clinically significant change as patient’s own impression. Follow-up interviews are conducted up to 6 months after the treatment.Ethics and disseminationThe study is performed in agreement with the Declaration of Helsinki and under approval by the governing ethical committees of each participating clinic. The results will be published according to the Consolidated Standards of Reporting Trials guidelines in a peer-reviewed journal.Trial registration numberNCT03112928; Pre-results.

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