Article

Mirror visual feedback (mirror therapy) is practiced worldwide in
very different ways to alleviate phantom pain; no study has compared these
variations yet or researched the associated risk and harm. OBJECTIVES: To
establish use and justification of a generally accepted mirror visual feedback
treatment plan after amputation; to explore the occurrence and handling of
adverse effects; and to increase knowledge about contributing factors. METHODS:
Experiential knowledge of 13 experienced practitioners from 6 countries and 5
professions was explored with a 3-round Delphi technique.
RESULTS: Experience
with the use of 5 different treatment plans was described, of which 1 has never
been mentioned in the literature: an intense 1-off plan in which the illusion was
carefully set up before the patient was left to the experience with no
interference, resolving pain as well as adverse effects. In the 4 known treatment
plans, the expectations of response time varied, which influenced the definition
of responders/nonresponders; the set-ups, control, and use of material reflected
the professional background of the practitioners. Contraindications also were
defined according to the professional confidence to deal with the adverse
effects. Adverse effects were reported, including emotional reactions, pain
increase, sensory changes, freezing of the phantom limb, dizziness, and sweating.
The attitude toward, and the handling of, adverse effects varied in patients as
in practitioners according to their professional background. A tool to fine tune
the experience was reported with covering of the limb during therapy. Full
consensus was reached on several treatment modalities.
CONCLUSION: Analysis of
the results suggests that the different treatment plans suit different patients
and practitioners. Matching these could enhance effectiveness and compliance.
Knowledge about adverse effects needs to inform treatment decisions. These
findings triggered the development of a mirror visual feedback gateway to guide
patients to the treatment plan for their needs, and to collect data from the
practitioners to enhance neuroscientific understanding and inform practice.
CI - Copyright (c) 2014 American Academy of Physical Medicine and Rehabilitation.
Published by Elsevier Inc. All rights reserved.

Langue : ANGLAIS