Rothgangel A, Braun S, Winkens B, et al. Traditional and augmented reality mirror therapy for patients with chronic phantom limb pain (PACT study): results of a three-group, multicentre single-blind randomized controlled trial. Clin Rehabil. 2018 Jul 1:269215518785948. doi: 10.1177/0269215518785948. (Original study)

OBJECTIVE: To compare the effects of traditional mirror therapy (MT), a patient-centred teletreatment (PACT) and sensomotor exercises without a mirror on phantom limb pain (PLP).

DESIGN: Three-arm multicentre randomized controlled trial.

SETTING: Rehabilitation centres, hospital and private practices.

SUBJECTS: Adult patients with unilateral lower limb amputation and average PLP intensity of at least 3 on the 0-10 Numeric Rating Scale (NRS).

INTERVENTIONS: Subjects randomly received either four weeks of traditional MT followed by a teletreatment using augmented reality MT, traditional MT followed by self-delivered MT or sensomotor exercises of the intact limb without a mirror followed by self-delivered exercises.

MAIN MEASURES: Intensity, frequency and duration of PLP and patient-reported outcomes assessing limitations in daily life at baseline, 4 weeks, 10 weeks and 6 months.

RESULTS: In total, 75 patients received traditional MT ( n = 25), teletreatment ( n = 26) or sensomotor exercises ( n = 24). Mean (SD) age was 61.1 (14.2) years and mean (SD) pain intensity was 5.7 (2.1) on the NRS. Effects of MT at four weeks on PLP were not significant. MT significantly reduced the duration of PLP at six months compared to the teletreatment ( P = 0.050) and control group ( P = 0.019). Subgroup analyses suggested significant effects on PLP in women, patients with telescoping and patients with a motor component in PLP. The teletreatment had no additional effects compared to self-delivered MT at 10 weeks and 6 months.

CONCLUSION: Traditional MT over four weeks was not more effective than sensomotor exercises without a mirror in reducing PLP, although significant effects were suggested in some subgroups.

Discipline Area Score
Physician 5 / 7
Rehab Clinician (OT/PT) 5 / 7
Comments from MORE raters

Rehab Clinician (OT/PT) rater

This is a very small sample for a 3-armed RCT. It would definitely be underpowered for subgp analyses. Thus, the conclusion should be considered in light of these facts.

Rehab Clinician (OT/PT) rater

Due the small number of subjects in the sub groups, one has to be careful looking at the conclusions of this study. This is a significant threat to the external validity of the study. It is does provide food for thought for those working with this subject group.

Rehab Clinician (OT/PT) rater

I am familiar with the early work in this area, results appear somewhat disappointing.
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