Telephysiotherapy for the treatment of phantom limb pain: a quasi-experimental study

Piazza, Amanda de Aguiar; Luz, Soraia Cristina Tonon da; Souza, Juliana Barcellos de; Vieira, Amábile Catarina; Medeiros, Amanda Borges

doi:10.63231/2595-0118.20250032-pt

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ORIGINAL ARTICLE • BrJP 8 • 2025 • https://doi.org/10.63231/2595-0118.20250032-en linkcopy

Telephysiotherapy for the treatment of phantom limb pain: a quasi-experimental study

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

BACKGROUND AND OBJECTIVES Phantom limb pain (PLP) is a common complication of limb amputation, with a prevalence ranging from 41% to 46% of cases. Despite its uncertain pathophysiology, evidence suggests multifactorial mechanisms to explain the painful phenomenon, which directly affects the individual's quality of life. This study aimed to analyze the possible influence of a telephysiotherapy protocol for PLP on quality of life, pain intensity, and pain perception in individuals with limb amputation, in a quasi-experimental context.

METHODS A quasi-experimental study with a qualitative-quantitative approach, involving a sample of nine individuals. The instruments used were the McGill Pain Questionnaire, a verbal pain scale, the Short-Form Health Survey (SF-36), and an assessment form designed as an interview, all applied before and after the treatment protocol. The intervention consisted of an adaptation of the Graded Motor Imagery (GMI) protocol, conducted online via the Google Meet platform. Quantitative analysis was performed using the paired Wilcoxon test for nonparametric variables. The qualitative approach was analyzed using content analysis methodology.

RESULTS No significant differences were observed in quality-of-life parameters, pain intensity, or pain perception. However, qualitative reports demonstrated a perceived improvement among participants.

CONCLUSION The divergence between qualitative and quantitative results highlights the need for the development of specific questionnaires for PLP and its impact on the quality of life of individuals with limb amputation.

Keywords:
Amputees; Phantom limb; Telehealth

HIGHLIGHTS

The article takes a quantitative and qualitative approach, since the qualitative part can contribute to understanding the experience of Phantom Limb Pain in individuals with amputated limbs

Another highlight is the very subject of Pain in the Phantom Limb, which is still little explored in literature, especially in the Brazilian context

Another highlight of is the use of telephysiotherapy, a resource that can be useful for treating individuals with mobility restrictions

Upper Limb Amputees (UL)	Lower Limb Amputees (LL)
Week 1:	Week 1:
Triple flexion (shoulder, elbow and wrist flexion combined);	Triple flexion (hip flexion, knee flexion and dorsiflexion combined);
Triple flexion combined with shoulder abduction.	Ankle dorsiflexion and plantiflexion.
Week 2 to 4/6:	Week 2 to 4/6:
Shoulder flexion and extension;	Hip flexion and extension;
Shoulder abduction and adduction;	Hip abduction and adduction;
Shoulder internal and external rotation;	Hip internal and external rotation;
Elbow flexion and extension;	Knee flexion and extension;
Wrist flexion and extension;	Ankle dorsiflexion and plantiflexion;
Wrist circumduction;	Ankle circumduction;
Finger extension and flexion.	Toe extension and flexion.

Identification	Gender	Age (years)	Marital Status	Schooling	Laterality	Profession
PLP1	F	65	Married	Graduation Complete	Right-handed	Retired
PLP2	M	22	Single	High School Complete	Right-handed	Athlete
PLP3	M	18	Single	High School Complete	Right-handed	Student
PLP4	F	80	Widower	Elementary School Complete	Right-handed	Retired
PLP5	M	62	Divorced	Graduation Complete	Right-handed	Retired
PLP6	F	51	Single	Elementary School Complete	Right-handed	Massotherapist
PLP7	M	60	Married	High School Complete	Right-handed	Retired
PLP8	F	59	Widower	High School Complete	Right-handed	Retired
PLP9	M	44	Married	Elementary School Complete	Right-handed	Salesman

Individual	Amputation time (months)	Level of amputation	Affected limb	Cause of amputation	Post-surgical complications	Associated conditions	Use of drugs	Use of prosthesis
PLP1	5	Hip disarticulation	LLL	Tumoral	NO	YES	YES	NO
PLP2	64	Transumeral	RUL	Traumatic	NO	NO	NO	NO
PLP3	2.5	Transfemoral	LLL	Infectious	YES	NO	YES	YES
PLP4	6	Transfemoral	RLL	Tumoral	YES	YES	YES	NO
PLP5	4	Transfemoral	LLL	Vascular	NO	YES	YES	NO
PLP6	3.5	Transtibial	LLL	Infectious	YES	YES	YES	NO
PLP7	1.5	Transtibial	RLL	Diabetes	YES	YES	YES	NO
PLP8	8.0	Transtibial	LLL	Diabetes	NO	NO	YES	NO
PLP9	2.0	Transfemoral	LLL	Traumatic	NO	NO	NO	NO

Variables	Pre-intervention	Post-intervention	P value
SF-36 Functional Capacity	46.1 [33]	47.8 [26]	0.79
SF-36 Physical Aspects	38.9 [40]	38.9 [25]	1.00
SF-36 Pain	43.3 [28]	42.9 [25]	0.88
SF-36 General Status	67.3 [31]	76.1 [24]	0.109
SF-36 Vitality	57.8 [30]	60.6 [16]	0.83
SF-36 Social Aspects	69.4 [25]	79.2 [18]	0.28
SF-36 Emotional Aspects	71.4 [41]	81.0 [33]	0.65
SF-36 Mental Health	78.7 [22]	86.2 [14]	0.43

Individual	Pre-assessment	S1	S2	S3	S4	S5	S6	S7	S8	Post-evaluation
PLP1	Moderate	Moderate	Intense	Intense	Painless	Painless	Painless	NA	NA	Painless
PLP2	Painless	Painless	Light	Light	Light	Mild	Painless	NA	NA	Painless
PLP3	Light	Light	Painless	Painless	Painless	Painless	Mild	Painless	NA	Painless
PLP4	Mild	Mild	Mild	Moderate	Painless	Painless	Mild	Painless	Painless	Painless
PLP5	Moderate	Moderate	Intense	Mild	Mild	Painless	Moderate	Mild	NA	Mild
PLP6	Light	Mild	Intense	Painless	Painless	Painless	Mild	NA	NA	Mild
PLP7	Painless	Painless	Painless	Painless	Painless	Painless	Painless	NA	NA	Mild
PLP8	Painless	Painless	Painless	Painless	Painless	Painless	Painless	NAPainless	NA	Painless
PLP9	Moderate	Mild	Moderate	Painless	Painless	Painless	Painless	Painless	NA	Moderate

Variables	Pre-intervention	Post-intervention	P value
Sensorial	20.2 [7.7]	12.8 [5.5]	0.09
Emotional	7.0 [2.2]	5.4 [0.9]	0.123
Cognitive	3.1 [1.8]	1.9 [1.1]	0.168
Miscellaneous	7.7 [3.4]	6.1 [1.8]	0.55
Total	38.0 [12.7]	27.8 [4.6]	0.078

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Sociedade Brasileira para o Estudo da Dor Av. Conselheiro Rodrigues Alves, 937 Cj2 - Vila Mariana, CEP: 04014-012, São Paulo, SP - Brasil, Telefones: , (55) 11 5904-2881/3959 - São Paulo - SP - Brazil
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[1] LLL = left lower limb; RUL = right upper limb; RLL = right lower limb.