Limakatso Katleho, Cashin Aidan G, Williams Sam, Devonshire Jack, Parker Romy, McAuley James H
School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia.
Centre for Pain IMPACT, Neuroscience Research Australia (NeuRA), Sydney, Australia.
Can J Pain. 2023 May 17;7(1):2188899. doi: 10.1080/24740527.2023.2188899. eCollection 2023.
Graded Motor Imagery (GMI) is a non-invasive and inexpensive therapy used to treat Phantom Limb Pain (PLP) by sequentially activating motor networks in such a way that movement and pain are unpaired. The objective of this systematic review was to critically appraise relevant data on the efficacy of GMI and its components for reducing PLP and disability in amputees.
We searched 11 electronic databases for controlled trials investigating GMI and its components in amputees with PLP from inception until February 2023. Two reviewers independently screened studies and extracted relevant data. Study-level data were entered using the inverse variance function of the Review Manager 5 and pooled with the random effects model.
Eleven studies with varying risk of bias were eligible. No eligible study considered left/right judgement tasks in isolation. Studies showed no effect for imagined movements, but positive effects were seen for GMI [weighted mean difference: -21.29 (95%CI: -31.55, -11.02), I= 0%] and mirror therapy [weighted mean difference: -8.55 (95%CI: -14.74, -2.35, I= 61%]. A comparison of mirror therapy versus sham showed no difference [weighted mean difference: -4.43 (95%CI: -16.03, 7.16), I= 51%].
Our findings suggest that GMI and mirror therapy may be effective for reducing PLP. However, this conclusion was drawn from a limited body of evidence, and the certainty of the evidence was very low. Therefore, rigorous, high-quality trials are needed to address the gap in the literature and inform practice.
分级运动想象（GMI）是一种非侵入性且成本低廉的治疗方法，通过按顺序激活运动网络，使运动和疼痛不再关联，从而用于治疗幻肢痛（PLP）。本系统评价的目的是严格评估有关GMI及其组成部分在减轻截肢者PLP和残疾方面疗效的相关数据。
我们检索了11个电子数据库，以查找自数据库建立至2023年2月期间，针对患有PLP的截肢者研究GMI及其组成部分的对照试验。两名评价员独立筛选研究并提取相关数据。使用Review Manager 5的逆方差函数输入研究水平的数据，并采用随机效应模型进行汇总。
11项偏倚风险各异的研究符合要求。没有符合要求的研究单独考虑左右判断任务。研究表明想象运动没有效果，但GMI [加权平均差：-21.29（95%可信区间：-31.55，-11.02），I² = 0%]和镜像疗法[加权平均差：-8.55（95%可信区间：-14.74，-2.35），I² = 61%]有积极效果。镜像疗法与假治疗的比较显示没有差异[加权平均差：-4.43（95%可信区间：-16.03，7.16），I² = 51%]。
我们的研究结果表明，GMI和镜像疗法可能对减轻PLP有效。然而，这一结论是基于有限的证据得出的，证据的确定性非常低。因此，需要进行严格、高质量的试验来填补文献中的空白并为实践提供依据。
