The effectiveness of graded motor imagery for reducing phantom limb pain in amputees: a randomised controlled trial

Objective To investigate whether graded motor imagery (GMI) is effective for reducing phantom limb pain (PLP) in people who have undergone limb amputations. Design A single-blinded randomised, controlled trial. Setting Physiotherapy out-patient departments in three secondary level hospitals in Cape Town, South Africa. Participants Twenty-one adults (>= 18 years) who had undergone unilateral upper or lower limb amputations and had self-reported PLP persisting beyond three months. Interventions A 6-week GMI programme was compared to routine physiotherapy. The study outcomes were evaluated at baseline, 6 weeks, 3 months and 6 months. Outcome measures The pain severity scale of the Brief Pain Inventory (BPI) was used to assess the primary outcome - PLP. The pain interference scale of the BPI and the EuroQol EQ-5D-5L were used to assess the secondary outcomes - pain interference with function and health-related quality of life (HRQoL) respectively. Results The participants in the experimental group had significantly greater improvements in pain than the control group at 6 weeks and 6 months. Further, the participants in the experimental group had significantly greater improvements than the control group in pain interference at all follow-up points. There was no between-group difference in HRQoL. Conclusion The results of the current study suggest that GMI is better than routine physiotherapy for reducing PLP. Based on the significant reduction in PLP and pain interference within the participants who received GMI, and the ease of application, GMI may be a viable treatment for treating PLP in people who have undergone limb amputations. (c) 2019 The Authors. Published by Elsevier Ltd on behalf of Chartered Society of Physiotherapy.