Research Department, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, USA.
Rehabilitation Science, University of Minnesota Twin Cities, Minneapolis, MN, USA.
Clin Rehabil. 2024 Mar;38(3):287-304. doi: 10.1177/02692155231204185. Epub 2023 Oct 17.
Three-phase graded motor imagery (limb laterality, explicit motor imagery, and mirror therapy) has been successful in chronic pain populations. However, when applied to phantom limb pain, an amputation-related pain, investigations often use mirror therapy alone. We aimed to explore evidence for graded motor imagery and its phases to treat phantom limb pain.
A scoping review was conducted following the JBI Manual of Synthesis and Preferred Reporting Items for Systematic Review and Meta-Analyses extension for Scoping Reviews. Thirteen databases, registers, and websites were searched.
Published works on any date prior to the search (August 2023) were included that involved one or more graded motor imagery phases for participants ages 18+ with amputation and phantom limb pain. Extracted data included study characteristics, participant demographics, treatment characteristics, and outcomes.
Sixty-one works were included representing 19 countries. Most were uncontrolled studies (31%). Many participants were male (75%) and had unilateral amputations (90%) of varying levels, causes, and duration. Most works examined one treatment phase (92%), most often mirror therapy (84%). Few works (3%) reported three-phase intervention. Dosing was inconsistent across studies. The most measured outcome was pain intensity (95%).
Despite the success of three-phase graded motor imagery in other pain populations, phantom limb pain research focuses on mirror therapy, largely ignoring other phases. Participant demographics varied, making comparisons difficult. Future work should evaluate graded motor imagery effects and indicators of patient success. The represented countries indicate that graded motor imagery phases are implemented internationally, so future work could have a widespread impact.
三相分级运动想象（肢体偏侧性、明确运动想象和镜像治疗）已在慢性疼痛人群中取得成功。然而，当应用于与截肢相关的幻肢痛时，研究通常仅使用镜像治疗。我们旨在探索分级运动想象及其阶段治疗幻肢痛的证据。
采用 JBI 手册的综合方法和用于系统评价和荟萃分析扩展的首选报告项目进行了范围综述。共检索了 13 个数据库、登记处和网站。
纳入了截止到 2023 年 8 月之前的任何日期发表的涉及年龄在 18 岁及以上的截肢和幻肢痛患者的一项或多项分级运动想象阶段的研究。提取的数据包括研究特征、参与者人口统计学、治疗特征和结果。
共纳入 61 项研究，代表 19 个国家。大多数为非对照研究（31%）。许多参与者为男性（75%），且存在单侧截肢（90%），截肢部位、原因和持续时间各不相同。大多数研究都检查了一个治疗阶段（92%），最常见的是镜像治疗（84%）。少数研究（3%）报告了三相干预。各研究之间的剂量不一致。最常测量的结果是疼痛强度（95%）。
尽管三相分级运动想象在其他疼痛人群中取得了成功，但幻肢痛研究主要集中在镜像治疗上，很大程度上忽略了其他阶段。参与者的人口统计学特征各不相同，使得比较变得困难。未来的工作应评估分级运动想象的效果和患者成功的指标。所代表的国家表明，分级运动想象阶段在国际上得到实施，因此未来的工作可能会产生广泛的影响。
