Development of a Clinical Framework for Mirror Therapy in Patients with Phantom Limb Pain: An Evidence‐based Practice Approach

Rothgangel, Andreas; Braun, Susy; Witte, Luc de; Beurskens, Anna; Smeets, Rob

doi:10.1111/papr.12301

Cited by 19 publications

(30 citation statements)

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“…Hence, it was essential to have a decision aid based on clear criteria that enabled systematic prioritization of user requirements and ensured the identification of the most critical requirements to include as a starting point in the first prototype of the telerehabilitation platform. To this end we developed a decision matrix reflecting the views of various stakeholders based on 3 different criteria: best available evidence [9], importance of the requirement, and the technical complexity (time or money) of implementing the requirement in the platform.…”

Section: Discussionmentioning

confidence: 99%

“…Best available evidence: A systematic literature review regarding the clinical framework of mirror therapy for patients with phantom limb pain was conducted in a preliminary stage [9]. Literature was screened to identify studies supporting the relevance of each reported user requirement.…”

Section: Methodsmentioning

confidence: 99%

“…Therefore, we recently developed an evidence-based clinical framework for mirror therapy for patients with phantom limb pain [9] that is currently being tested for effectiveness in a multicenter randomized controlled trial [10]. Given the chronic nature of phantom limb pain, continuous training with at least one session a day over a period of several weeks to months seems to be needed to achieve sustainable treatment effects [7].…”

Section: Introductionmentioning

confidence: 99%

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Design and Development of a Telerehabilitation Platform for Patients With Phantom Limb Pain: A User-Centered Approach

Rothgangel

Braun

Smeets

et al. 2017

JMIR Rehabil Assist Technol

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BackgroundPhantom limb pain is a frequent and persistent problem following amputation. Achieving sustainable favorable effects on phantom limb pain requires therapeutic interventions such as mirror therapy that target maladaptive neuroplastic changes in the central nervous system. Unfortunately, patients’ adherence to unsupervised exercises is generally poor and there is a need for effective strategies such as telerehabilitation to support long-term self-management of patients with phantom limb pain.ObjectiveThe main aim of this study was to describe the user-centered approach that guided the design and development of a telerehabilitation platform for patients with phantom limb pain. We addressed 3 research questions: (1) Which requirements are defined by patients and therapists for the content and functions of a telerehabilitation platform and how can these requirements be prioritized to develop a first prototype of the platform? (2) How can the user interface of the telerehabilitation platform be designed so as to match the predefined critical user requirements and how can this interface be translated into a medium-fidelity prototype of the platform? (3) How do patients with phantom limb pain and their treating therapists judge the usability of the medium-fidelity prototype of the telerehabilitation platform in routine care and how can the platform be redesigned based on their feedback to achieve a high-fidelity prototype?MethodsThe telerehabilitation platform was developed using an iterative user-centered design process. In the first phase, a questionnaire followed by a semistructured interview was used to identify the user requirements of both the patients and their physical and occupational therapists, which were then prioritized using a decision matrix. The second phase involved designing the interface of the telerehabilitation platform using design sketches, wireframes, and interface mock-ups to develop a low-fidelity prototype. Heuristic evaluation resulted in a medium-fidelity prototype whose usability was tested in routine care in the final phase, leading to the development of a high-fidelity prototype.ResultsA total of 7 categories of patient requirements were identified: monitoring, exercise programs, communication, settings, background information, log-in, and general requirements. One additional category emerged for therapists: patient management. Based on these requirements, patient and therapist interfaces for the telerehabilitation platform were developed and redesigned by the software development team in an iterative process, addressing the usability problems that were reported by the users during 4 weeks of field testing in routine care.ConclusionsOur findings underline the importance of involving the users and other stakeholders early and continuously in an iterative design process, as well as the need for clear criteria to identify critical user requirements. A decision matrix is presented that incorporates the views of various stakeholders in systematically rating and prioritizing user requi...

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Design and Development of a Telerehabilitation Platform for Patients With Phantom Limb Pain: A User-Centered Approach

Rothgangel

Braun

Smeets

et al. 2017

JMIR Rehabil Assist Technol

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“…Some patients have described cramps when "performing voluntary phantom limb movement" (confirmed by mirror projection). Due to the risk of worsening pain, some physiotherapists prefer evolving to voluntary movements only after reaching painless movement amplitude in the phantom limb mirror projection 86,87 . This phenomenon has also been described in CRPS patients 88 .…”

Section: Phantom Limb Painmentioning

confidence: 99%

Physical rehabilitation to treat neuropathic pain

Souza¹,

Carqueja

Baptista³

2016

Revista Dor

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“…A common complaint among amputees is phantom limb pain (PLP), a phenomenon in which unpleasant sensations, often painful and severe, are perceived to originate from an absent limb. PLP occurs in 50%-80% of amputees, and there is no consistent evidence to support any specific pain control modality or intervention in this setting (1,(3)(4)(5)(6)(7). The objectives of this study were to (a) evaluate the safety and feasibility of …”

mentioning

confidence: 99%

Percutaneous image-guided cryoablation for the treatment of phantom limb pain in amputees: a pilot study

Prologo

Gilliland

Yamada

et al. 2016

Journal of Vascular and Interventional Radiology

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Purpose-To prospectively evaluate percutaneous image-guided nerve cryoablation for treatment of refractory phantom limb pain (PLP) in a pilot cohort for purposes of deriving parameters to design a larger, randomized, parallel-armed, controlled trial. Materials and Methods-FromJanuary 2015 to January 2016, 21 patients with refractory PLP underwent image-guided percutaneous cryoneurolysis procedures. Visual analog scale scores were documented at baseline and 7, 45, and 180 days after the procedure. Responses to a modified Roland Morris Disability Questionnaire were documented at baseline and 7 and 45 days after the procedure.Results-Technical success rate of the procedures was 100%. There were 6 (29%) minor procedure-related complications. Disability scores decreased from a baseline mean of 11.3 to 3.3 at 45-day follow-up (95% confidence interval 5.8, 10.3; P < .0001). Pain intensity scores decreased from a baseline mean of 6.2 to 2.0 at long-term follow-up (95% confidence interval 2.8, 5.6; P < .0001).Conclusions-Image-guided percutaneous nerve cryoablation is feasible and safe and may represent a new efficacious therapeutic option for patients with phantom pains related to limb loss.Approximately 185,000 amputations are performed each year in the United States, and studies estimate that nearly 3.6 million people will be living with limb loss worldwide by 2050 (1,2). A common complaint among amputees is phantom limb pain (PLP), a phenomenon in which unpleasant sensations, often painful and severe, are perceived to originate from an absent limb. PLP occurs in 50%-80% of amputees, and there is no consistent evidence to support any specific pain control modality or intervention in this setting (1,(3)(4)(5)(6)(7). The objectives of this study were to (a) evaluate the safety and feasibility of HHS Public Access Author Manuscript Author ManuscriptAuthor ManuscriptAuthor Manuscript a separated 2-step procedural methodology consisting of computed tomography (CT)-guided perineural diagnostic injection and cryoablation in the setting of refractory PLP; (b) confirm the reproducibility of treatment response in relation to the findings of previous studies; and (c) derive estimates for key study parameters, such as recruitment rates, potentially confounding variables, and the treatment effect and its variation to inform the planning and design of a larger, parallel-armed, randomized controlled clinical trial investigating the efficacy of cryoablation for the treatment of PLP. MATERIALS AND METHODSThis study was approved by the university institutional review board and complied with the Health Insurance Portability and Accountability Act. The trial was registered before patient enrollment on ClinicalTrials.gov (NCT02366832). SubjectsSubjects were recruited from January 2015 to January 2016 from local vascular surgery, orthopedic surgery, and physical medicine and rehabilitation practices. All patients reported phantom pains and/or unwanted sensations related to a previously amputated upper or lower limb that were refr...

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Development of a Clinical Framework for Mirror Therapy in Patients with Phantom Limb Pain: An Evidence‐based Practice Approach

Abstract: In this study, a structured clinical framework for the application of MT in patients with PLP was developed. This framework is currently being tested for its effectiveness in a multicenter randomized controlled trial.

Cited by 19 publications

References 47 publications

Design and Development of a Telerehabilitation Platform for Patients With Phantom Limb Pain: A User-Centered Approach

Design and Development of a Telerehabilitation Platform for Patients With Phantom Limb Pain: A User-Centered Approach

Physical rehabilitation to treat neuropathic pain

Percutaneous image-guided cryoablation for the treatment of phantom limb pain in amputees: a pilot study

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