Physiology of Exercise and Activities in Extreme Conditions Unit, Armed Forces Biomedical Research Institute, Bretigny-sur-Orge, France.
Institute of Functional Genomics, University of Montpellier, CNRS, INSERM, Montpellier, France.
Eur J Pain. 2023 Jan;27(1):3-13. doi: 10.1002/ejp.2035. Epub 2022 Sep 19.
Phantom limb pain (PLP) concerns >50% of amputees and has a negative impact on their rehabilitation, mental health and quality of life. Mirror therapy (MT) is a promising strategy, but its effectiveness remains controversial. We performed a systematic review to: (i) evaluate the effectiveness of MT versus placebo in reducing PLP, and (ii) determine MT effect on disability and quality of life.
We selected randomized-controlled trials in five databases (Medline, Cochrane Library, CINAHL, PEDro and Embase) that included patients with unilateral lower or upper limb amputation and PLP and that compared the effects on PLP of MT versus a placebo technique. The primary outcome was PLP intensity changes and the secondary outcomes were PLP duration, frequency, patients' disability and quality of life.
Among the five studies included, only one reported a significant difference between the MT group and control group, with a positive MT effect at week 4. Only one study assessed MT effect on disability and found a significant improvement in the MT group at week 10 and month 6.
Our systematic review did not allow concluding that MT reduces PLP and disability in amputees. This lack of strong evidence is probably due to (i) the low methodological quality of the included studies, and (ii) the lack of statistical power. Future trials should include a higher number of patients, increase the number and frequency of MT sessions, have a long-term follow-up and improve the methodological quality.
Recent meta-analyses concluded that MT is effective for reducing phantom limb pain. Conversely, the present systematic review that included only studies with the best level of evidence did not find any evidence about its effectiveness for this condition. We identified many ways to improve future randomized-controlled trials on this topic: increasing the number of participants, reducing the intra-group heterogeneity, using a suitable placebo and intensifying the MT sessions and frequency.
幻肢痛（PLP）困扰着>50%的截肢患者，并对其康复、心理健康和生活质量产生负面影响。镜像疗法（MT）是一种很有前途的策略，但它的有效性仍存在争议。我们进行了一项系统评价，以：（i）评估 MT 与安慰剂在减轻 PLP 方面的效果，（ii）确定 MT 对残疾和生活质量的影响。
我们在五个数据库（Medline、Cochrane Library、CINAHL、PEDro 和 Embase）中选择了随机对照试验，这些试验纳入了单侧下肢或上肢截肢且伴有 PLP 的患者，并比较了 MT 与安慰剂技术对 PLP 的影响。主要结局是 PLP 强度的变化，次要结局是 PLP 的持续时间、频率、患者的残疾和生活质量。
在纳入的五项研究中，只有一项报告了 MT 组和对照组之间的显著差异，MT 在第 4 周有积极的效果。只有一项研究评估了 MT 对残疾的影响，发现 MT 组在第 10 周和第 6 个月有显著改善。
我们的系统评价没有得出 MT 可以减轻截肢患者的 PLP 和残疾的结论。这种缺乏强有力证据的情况可能是由于：（i）纳入研究的方法学质量较低，以及（ii）缺乏统计学效力。未来的试验应纳入更多的患者，增加 MT 治疗的次数和频率，进行长期随访，并提高方法学质量。
最近的荟萃分析得出结论，MT 对减轻幻肢痛有效。相反，本系统评价仅纳入了证据水平最高的研究，并未发现任何关于其对这种疾病有效的证据。我们确定了许多改进这一主题的未来随机对照试验的方法：增加参与者的数量，减少组内异质性，使用合适的安慰剂，并加强 MT 治疗的次数和频率。
