ORIGINAL PAPER
Effects of routine physical therapy with and without mirror therapy on phantom limb pain and psychosocial adjustment to amputation among prosthetic users
 
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University Institute of Physical Therapy, Faculty of Allied Health Sciences, University of Lahore, Lahore, Pakistan
 
 
Submission date: 2021-05-01
 
 
Acceptance date: 2021-06-09
 
 
Publication date: 2022-04-27
 
 
Physiother Quart. 2022;30(2):8-14
 
KEYWORDS
TOPICS
ABSTRACT
Introduction:
The study objective was to determine the effect of conventional physiotherapy treatment with and without mirror therapy on phantom limb pain and psychosocial adjustment to amputation among prosthesis wearers.

Methods:
It was a randomized controlled trial. Data were collected in the Physiotherapy Department of the Pakistan Society for the Rehabilitation of the Disabled, Lahore, and University of Lahore teaching hospital, Lahore. Overall, 36 participants with unilateral lower extremity traumatic amputation and phantom limb pain were recruited.

Results:
At baseline, the experimental and control groups were comparable for both Numeric Pain Rating Scale (6.17 ± 1.80 and 6.33 ± 1.74) and psychosocial adjustment of the Trinity Amputation and Prosthesis Experience Scales, i.e. general adjustment (19.22 ± 2.39 and 19.67 ± 2.76), adjustment to limitation (12.78 ± 4.36 and 11.72 ± 3.69), and social adjustment (20.22 ± 1.83 and 20.05 ± 2.87). At the end of the 4th week, a significant reduction in pain was observed (2.27 ± 1.17 and 4 ± 1.37). Changes were recorded in general adjustment (22.27 ± 2.63 and 21.89 ± 2.21) and adjustment to limitation (19.67 ± 2.54 and 16.00 ± 3.97) but no significant difference was seen in social adjustment (22.67 ± 1.90 and 21.89 ± 1.99).

Conclusions:
Mirror therapy combined with routine physical therapy is a beneficial approach and shows better results in mitigating phantom limb pain and in psychosocial adjustment to the prosthesis than routine physical therapy alone.

REFERENCES (41)
1.
Solarz MK, Thoder JJ, Rehman S. Management of major traumatic upper extremity amputations. Orthop Clin North Am. 2016;47(1):127–136; doi: 10.1016/j.ocl.2015.08.013.
 
2.
Penn-Barwell JG, Kendrew J, Sargeant ID. Amputation. In: Breeze J, Penn-Barwell JG, Keene D, O’Reilly D, Je­ya­nathan J, Mahoney PF (eds.), Ballistic trauma. A practical guide. Cham: Springer; 2017; 491–503.
 
3.
Day MC, Wadey R, Strike S. Living with limb loss: everyday experiences of “good” and “bad” days in people with lower limb amputation. Disabil Rehabil. 2019;41(20):2433–2442; doi: 10.1080/09638288.2018.1467502.
 
4.
Bekrater-Bodmann R, Schredl M, Diers M, Reinhard I, Foell J, Trojan L, et al. Post-amputation pain is associated with the recall of an impaired body representation in dreams – results from a nation-wide survey on limb amputees. PLoS One. 2015;10(3):e0119552; doi: 10.1371/journal.pone.0119552.
 
5.
Chan AW-Y, Bilger E, Griffin S, Elkis V, Weeks S, Hussey-Anderson L, et al. Visual responsiveness in sensorimotor cortex is increased following amputation and reduced after mirror therapy. Neuroimage Clin. 2019;23:101882; doi: 10.1016/j.nicl.2019.101882.
 
6.
Noguchi S, Saito J, Nakai K, Kitayama M, Hirota K. Factors affecting phantom limb pain in patients undergoing amputation: retrospective study. J Anesth. 2019;33(2):216–220; doi: 10.1007/s00540-018-2599-0.
 
7.
Collins KL, Russell HG, Schumacher PJ, Robinson-Freeman KE, O’Conor EC, Gibney KD, et al. A review of current theories and treatments for phantom limb pain. J Clin Invest. 2018;128(6):2168–2176; doi: 10.1172/JCI94003.
 
8.
Helander EM, Eskander JP, Juneau CL, Novitch MB, Prabhakar A, DeKerlegand AM, et al. Preemptive analgesia, regional anesthesia, and prevention of chronic postoperative pain. In: Kaye AD, Urman RD, Vadivelu N (eds.), Essentials of regional anesthesia. Cham: Springer; 2018; 445–462.
 
9.
Christensen J, Ipsen T, Doherty P, Langberg H. Physical and social factors determining quality of life for veterans with lower-limb amputation(s): a systematic review. Disabil Rehabil. 2016;38(24):2345–2353; doi: 10.3109/09638288.2015.1129446.
 
10.
Baars EC, Schrier E, Dijkstra PU, Geertzen JHB. Prosthesis satisfaction in lower limb amputees: a systematic review of associated factors and questionnaires. Medicine. 2018;97(39):e12296; doi: 10.1097/MD.0000000000012296.
 
11.
Nikolajsen L, Christensen KF. Phantom limb pain. In: Tubbs RS, Rizk E, Shoja MM, Loukas M, Barbaro N, Spinner RJ (eds.), Nerves and nerve injuries. London: Academic Press; 2015; 23–34.
 
12.
Johnson MI, Jones G, Paley CA, Wittkopf PG. The clinical efficacy of transcutaneous electrical nerve stimulation (TENS) for acute and chronic pain: a protocol for a meta-analysis of randomised controlled trials (RCTs). BMJ Open. 2019;9(10):e029999; doi: 10.1136/bmjopen-2019-029999.
 
13.
Corbett M, South E, Harden M, Eldabe S, Pereira E, Sedki I, et al. Brain and spinal stimulation therapies for phantom limb pain: a systematic review. Health Technol Assess. 2018;22(62):1–94; doi: 10.3310/hta22620.
 
14.
Dietrich C, Nehrdich S, Seifert S, Blume KR, Miltner WHR, Hofmann GO, et al. Leg prosthesis with somatosensory feedback reduces phantom limb pain and increases functionality. Front Neurol. 2018;9:270; doi: 10.3389/fneur.2018.00270.
 
15.
Pinto CB, Velez FGS, Bolognini N, Crandell D, Merabet LB, Fregni F. Optimizing rehabilitation for phantom limb pain using mirror therapy and transcranial direct current stimulation: a randomized, double-blind clinical trial study protocol. JMIR Res Protoc. 2016;5(3):e138; doi: 10.2196/resprot.5645.
 
16.
Trevelyan EG, Turner WA, Summerfield-Mann L, Robinson N. Acupuncture for the treatment of phantom limb syndrome in lower limb amputees: a randomised controlled feasibility study. Trials. 2016;17(1):519; doi: 10.1186/s13063-016-1639-z.
 
17.
Herrador Colmenero L, Perez Marmol JM, Martí-García C, de Los Ángeles Querol Zaldivar M, Haro RMT, Castro Sánchez AM, et al. Effectiveness of mirror therapy, motor imagery, and virtual feedback on phantom limb pain following amputation: a systematic review. Prosthet Orthot Int. 2018;42(3):288–298; doi: 10.1177/0309364617740230.
 
18.
Kelle B, Kozanoğlu E, Biçer ÖS, Tan I. Association between phantom limb complex and the level of amputation in lower limb amputee. Acta Orthop Traumatol Turc. 2017;51(2):142–145; doi: 10.1016/j.aott.2017.02.007.
 
19.
Deconinck FJA, Smorenburg ARP, Benham A, Ledebt A, Feltham MG, Savelsbergh GJP. Reflections on mirror therapy: a systematic review of the effect of mirror visual feedback on the brain. Neurorehabil Neural Repair. 2015;29(4):349–361; doi: 10.1177/1545968314546134.
 
20.
Osumi M, Inomata K, Inoue Y, Otake Y, Morioka S, Sumitani M. Characteristics of phantom limb pain alleviated with virtual reality rehabilitation. Pain Med. 2019;20(5):1038–1046; doi: 10.1093/pm/pny269.
 
21.
Aternali A, Katz J. Recent advances in understanding and managing phantom limb pain. F1000Res. 2019;8:1167; doi: 10.12688/f1000research.19355.1.
 
22.
Anaforoğlu Külünkoğlu B, Erbahçeci F, Alkan A. A comparison of the effects of mirror therapy and phantom exercises on phantom limb pain. Turk J Med Sci. 2019;49(1):101–109; doi: 10.3906/sag-1712-166.
 
23.
Yıldırım M, Kanan N. The effect of mirror therapy on the management of phantom limb pain. Agri. 2016;28(3):127–134; doi: 10.5505/agri.2016.48343.
 
24.
Tilak M, Isaac SA, Fletcher J, Vasanthan LT, Subbaiah RS, Babu A, et al. Mirror therapy and transcutaneous electrical nerve stimulation for management of phantom limb pain in amputees – a single blinded randomized controlled trial. Physiother Res Int. 2016;21(2):109–115; doi: 10.1002/pri.1626.
 
25.
Rothgangel A, Braun S, Winkens B, Beurskens A, Smeets R. 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. Clin Rehabil. 2018;32(12):1591–1608; doi: 10.1177/0269215518785948.
 
26.
Ülger Ö, Topuz S, Bayramlar K, Şener G, Erbahçeci F. Effectiveness of phantom exercises for phantom limb pain: a pilot study. J Rehabil Med. 2009;41(7):582–584; doi: 10.2340/16501977-0380.
 
27.
Finn SB, Perry BN, Clasing JE, Walters LS, Jarzombek SL, Curran S, et al. A randomized, controlled trial of mirror therapy for upper extremity phantom limb pain in male amputees. Front Neurol. 2017;8:267; doi: 10.3389/fneur.2017.00267.
 
28.
Griffin SC, Curran S, Chan AWY, Finn SB, Baker CI, Pasquina PF, et al. Trajectory of phantom limb pain relief using mirror therapy: retrospective analysis of two studies. Scand J Pain. 2017;15(1):98–103; doi: 10.1016/j.sjpain.2017.01.007.
 
29.
Casale R, Damiani C, Rosati V. Mirror therapy in the rehabilitation of lower-limb amputation: are there any contraindications? Am J Phys Med Rehabil. 2009;88(10):837–842; doi: 10.1097/PHM.0b013e3181b74698.
 
30.
Brodie EE, Whyte A, Niven CA. Analgesia through the looking-glass? A randomized controlled trial investigating the effect of viewing a ‘virtual’ limb upon phantom limb pain, sensation and movement. Eur J Pain. 2007;11(4):428–436; doi: 10.1016/j.ejpain.2006.06.002.
 
31.
Brodie EE, Whyte A, Waller B. Increased motor control of a phantom leg in humans results from the visual feedback of a virtual leg. Neurosci Lett. 2003;341(2):167–169; doi: 10.1016/s0304-3940(03)00160-5.
 
32.
Mawdsley RH, Moran KA, Conniff LA. Reliability of two commonly used pain scales with elderly patients. J Geriatr Phys Ther. 2002;25(3):16–20; doi: 10.1519/00139143-200124030-00037.
 
33.
Pereira MG, Ramos C, Lobarinhas A, Cunha Machado J, Pedras S. Satisfaction with life in individuals with a lower limb amputation: the importance of active coping and acceptance. Scand J Psychol. 2018;59(4):414–421; doi: 10.1111/sjop.12444.
 
34.
Gallagher P, MacLachlan M. Development and psychometric evaluation of the Trinity Amputation and Prosthesis Experience Scales (TAPES). Rehabil Psychol. 2000;45(2):130–154; doi: 10.1037/0090-5550.45.2.130.
 
35.
Badii M, Wade AN, Collins DR, Nicolaou S, Kobza BJ, Kopec JA. Comparison of lifts versus tape measure in determining leg length discrepancy. J Rheumatol. 2014;41(8):1689–1694; doi: 10.3899/jrheum.131089.
 
36.
Chan BL, Witt R, Charrow AP, Magee A, Howard R, Pasquina PF, et al. Mirror therapy for phantom limb pain. N Engl J Med. 2007;357(21):2206–2207; doi: 10.1056/NEJMc071927.
 
37.
Rothgangel AS, Braun SM, Beurskens AJ, Seitz RJ, Wade DT. The clinical aspects of mirror therapy in rehabilitation: a systematic review of the literature. Int J Rehabil Res. 2011;34(1):1–13; doi: 10.1097/MRR.0b013e3283441e98.
 
38.
Darnall BD. Self-delivered home-based mirror therapy for lower limb phantom pain. Am J Phys Med Rehabil. 2009;88(1):78–81; doi: 10.1097/PHM.0b013e318191105b.
 
39.
Barbin J, Seetha V, Casillas JM, Paysant J, Pérennou D. The effects of mirror therapy on pain and motor control of phantom limb in amputees: a systematic review. Ann Phys Rehabil Med. 2016;59(4):270–275; doi: 10.1016/j.rehab.2016.04.001.
 
40.
Moseley GL. Graded motor imagery for pathologic pain: a randomized controlled trial. Neurology. 2006;67(12):2129–2134; doi: 10.1212/01.wnl.0000249112.56935.32.
 
41.
Desmond D, Gallagher P, Henderson-Slater D, Chatfield R. Pain and psychosocial adjustment to lower limb amputation amongst prosthesis users. Prosthet Orthot Int. 2008;32(2):244–252; doi: 10.1080/03093640802067046.
 
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