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- Lendaro, Eva, 1989, et al.
(author)
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Phantom motor execution as a treatment for phantom limb pain: Protocol of an international, double-blind, randomised controlled clinical trial
- 2018
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In: BMJ Open. - : BMJ. - 2044-6055 .- 2044-6055. ; 8:7
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Journal article (peer-reviewed)abstract
- Introduction Phantom limb pain (PLP) is a chronic condition that can greatly diminish quality of life. Control over the phantom limb and exercise of such control have been hypothesised to reverse maladaptive brain changes correlated to PLP. Preliminary investigations have shown that decoding motor volition using myoelectric pattern recognition, while providing real-time feedback via virtual and augmented reality (VR-AR), facilitates phantom motor execution (PME) and reduces PLP. Here we present the study protocol for an international (seven countries), multicentre (nine clinics), double-blind, randomised controlled clinical trial to assess the effectiveness of PME in alleviating PLP. Methods and analysis Sixty-seven subjects suffering from PLP in upper or lower limbs are randomly assigned to PME or phantom motor imagery (PMI) interventions. Subjects allocated to either treatment receive 15 interventions and are exposed to the same VR-AR environments using the same device. The only difference between interventions is whether phantom movements are actually performed (PME) or just imagined (PMI). Complete evaluations are conducted at baseline and at intervention completion, as well as 1, 3 and 6 months later using an intention-to-treat (ITT) approach. Changes in PLP measured using the Pain Rating Index between the first and last session are the primary measure of efficacy. Secondary outcomes include: Frequency, duration, quality of pain, intrusion of pain in activities of daily living and sleep, disability associated to pain, pain self-efficacy, frequency of depressed mood, presence of catastrophising thinking, health-related quality of life and clinically significant change as patient's own impression. Follow-up interviews are conducted up to 6 months after the treatment. Ethics and dissemination The study is performed in agreement with the Declaration of Helsinki and under approval by the governing ethical committees of each participating clinic. The results will be published according to the Consolidated Standards of Reporting Trials guidelines in a peer-reviewed journal.
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- Postema, Sietke G., et al.
(author)
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Musculoskeletal Complaints in Transverse Upper Limb Reduction Deficiency and Amputation in The Netherlands : Prevalence, Predictors, and Effect on Health
- 2016
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In: Archives of Physical Medicine and Rehabilitation. - Philadelphia, USA : Saunders Elsevier. - 0003-9993 .- 1532-821X. ; 97:7, s. 1137-1145
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Journal article (peer-reviewed)abstract
- Objective: (1) To determine the prevalence of musculoskeletal complaints (MSCs) in individuals with upper limb absence in The Netherlands, (2) to assess the health status of individuals with upper limb absence in general and in relation to the presence of MSCs, and (3) to explore the predictors of development of MSCs and MSC-related disability in this population.Design: Cross-sectional study: national survey.Setting: Twelve rehabilitation centers and orthopedic workshops.Partiscipants: Individuals (n=263; mean age, 50.7±16.7y; 60% men) ≥18 years old, with transverse upper limb reduction deficiency (42%) or amputation (58%) at or proximal to the carpal level (response, 45%) and 108 individuals without upper limb reduction deficiency or amputation (n=108; mean age, 50.6±15.7y; 65% men) (N=371).Interventions: Not applicable.Main outcome measures: Point and year prevalence of MSCs, MSC-related disability (Pain Disability Index), and general health perception and mental health (RAND-36 subscales).Results: Point and year prevalence of MSCs were almost twice as high in individuals with upper limb absence (57% and 65%, respectively) compared with individuals without upper limb absence (27% and 34%, respectively) and were most often located in the nonaffected limb and upper back/neck. MSCs were associated with decreased general health perception and mental health and higher perceived upper extremity work demands. Prosthesis use was not related to presence of MSCs. Clinically relevant predictors of MSCs were middle age, being divorced/widowed, and lower mental health. Individuals with upper limb absence experienced more MSC-related disability than individuals without upper limb absence. Higher age, more pain, lower general and mental health, and not using a prosthesis were related to higher disability.Conclusions: Presence of MSCs is a frequent problem in individuals with upper limb absence and is associated with decreased general and mental health. Mental health and physical work demands should be taken into account when assessing such a patient. Clinicians should note that MSC-related disability increases with age.
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- Postema, Sietke, et al.
(author)
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Upper limb absence : predictors of work participation and work productivity
- 2016
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In: Archives of Physical Medicine and Rehabilitation. - Philadelphia, USA : Elsevier. - 0003-9993 .- 1532-821X. ; 97:6, s. 892-899
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Journal article (peer-reviewed)abstract
- Objective: to analyze work participation, work productivity and contributing factors, as well as physical work demands, in individuals with an upper limb defect (ULD).Design: cross-sectional study: postal survey (response rate: 53%).Setting: patients of twelve rehabilitation centers and orthopedic workshops in the Netherlands.Participants: 207 individuals with unilateral transversal upper limb reduction deficiency (ULRD) or amputation (ULA), at or proximal to the carpal level, between the ages of 18 and 65 years, and a convenience sample of 90 controls (matched on age and gender).Interventions: not applicable.Main outcome measures: employment status, self-reported work productivity and self-reported upper extremity work demands.Results: 74% of individuals with ULRD and 57% of the individuals with ULA were employed. Males, using a prosthesis, with medium or higher level of education and good general health were most often employed. Work productivity was similar to the control group. Higher work productivity was related to predominantly mentally demanding type of work and less MSC related pain. Upper extremity work demands were higher in individuals with ULD with predominantly mentally demanding work, compared to controls with this type of work. Conclusions: the outcome of work participation of individuals with ULRD is comparable to the general population in the Netherlands. Individuals with ULA had lower rates of employment. Work productivity was not associated to one-handedness.
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