Bohatsu ke letšoao le tloaelehileng ho batho ba lahlehetsoeng ke letsoho kapa leoto. Sena se tla fokotsa bohloko bo utloiloeng likarolong tse amehileng tsa 'mele, ho lebisa tlhokomelo mekhoeng e ka sehloohong e amehang le ho fetola maemo a kotsi.
Introduction
- Research rationale
- Research questions
- Research aim
- Objectives
- Ethical approval to conduct research
- Reporting structure
To determine an overall estimate of the prevalence of PLP in people with limb amputations (systematic review and meta-analysis). To determine the prevalence of PLP in a sample of African limb amputees (a cross-sectional study).
The prevalence and risk factors for phantom limb pain in people with amputations: A
Publication reference
Declarations from authors and co-authors
- Declaration from author
- Declaration of co-authors
Potential conflicts of interest were disclosed to (a) the awarding authorities, (b) the editor or publisher of journals or other publications, and (c) the head of the responsible academic unit. The original data is stored in the following location and will be stored for 10 years from the date of completion of the study.
Background and motivation
However, there is a lack of research aimed at systematically reviewing the literature on the role of preoperative, perioperative and postoperative risk factors for PLP. Exposure to risk factors has been shown to increase the risk of developing and maintaining PLP in people with pain-prone phenotypes (41).
Aims and objectives
- Aim
- Objectives
There is increasing evidence supporting the role of different mechanisms underlying PLP: spontaneous nociceptive firing against a neuroma, cortical sensory-motor mismatch, maladaptive cortical. Knowledge of modifiable risk factors that are consistently positively associated with PLP may allow healthcare professionals to identify treatment targets in hopes of preventing and managing PLP.
Summary of main findings
Manuscript published in PLOSONE
- Abstract
A subgroup analysis showing the pooled estimated prevalence of PLP in studies with a low risk of bias. Were the numerator(s) and denominator(s) for the outcome of interest (e.g., prevalence of PLP) appropriate?
Declaration from author and co-authors
- Declaration from author
- Declaration of co-authors
The above statement correctly reflects the nature and extent of the candidate's contribution to this work and the nature of the contribution of each of the co-authors. They meet the criteria for authorship in that they have participated in the design, execution or interpretation of at least that part of the publication within their field of expertise. They take public responsibility for their part of the publication, except for the responsible author, who assumes overall responsibility for the publication.
Potential conflicts of interest have been disclosed to awarding bodies, the editor or publisher of journals or other publications, and the head of the responsible academic unit. The peer-reviewed manuscript developed from this study has been shared on OpenUCT (www.open.uct.ac.za/katleho_limakatso) in accordance with the Open Access Policy at UCT.
Background and motivation
The high proportion of diabetes-related amputations may be an artifact of late screening, poor implementation of preventive strategies, and lack of consistent management of diabetes and its associated complications. Given the high rate of limb amputations and exposure to multiple socioeconomic risk factors for pain commonly present in South Africa, a significant proportion of South African amputees may suffer from PLP. . Based on this idea, we conceived the present study with the aim of exploring the prevalence of PLP and identifying associated risk factors in a sample of African people with amputations.
Aims and objectives
- Aim
- Objectives
Summary of main findings
Manuscript prepared for submission to the European Journal of Pain
- Abstract
Interestingly, no studies could be found that were conducted to determine the prevalence of PLP in the African population. In addition, increased knowledge of risk factors for PLP in this patient group may lead to more effective and targeted post-amputation care. The presence of PLP was assessed using the Brief Pain Inventory (BPI) pain intensity scale (Appendix 8) (138).
In the past week, have you experienced phantom pain in a limb—pain in a limb that is gone?” The BPI pain intensity scale was also used to assess the participant's worst, average, and lowest PLP in the past week, and their current PLP on a scale from zero to 10, where zero represents "no PLP" and 10 represents "worst PLP". you could imagine". The prevalence of PLP was calculated by dividing the number of cases of PLP by the number of cases of amputation.
Treatment recommendations for phantom limb pain in people with amputations: an
Publication reference
Declaration from author and co-authors
- Declaration from author
- Declaration of co-authors
Backup data was stored on an external hard drive and shared on a secure online data repository.
Background and motivation
Systematic reviews and meta-analyses provide us with the best form of evidence on a topic of interest because their approach to data analysis is more comprehensive, rigorous and robust compared to approaches used in other study designs. The current NICE guidelines for the management of neuropathic pain conditions may not be appropriate for PLP due to a lack of positive results for the recommended treatments. The poor evidence for pharmacological treatments and the inability to perform meta-analyses for non-pharmacological interventions (due to the use of different treatment protocols and study methodologies) means that the consensus on the best management of PLP must be generated by an alternative approach.
The Delphi method is useful when there is limited evidence on a particular topic of interest, and recommendations could be derived from the collective subjective judgments of experts (174).
Aim
Summary of main findings
Consensus was reached on seven treatments that were considered effective for the management of PLP, and on two treatments [citalopram (60%) and pulsed radiofrequency stimulation (PRFS) of the dorsal root ganglion (70%)] that were considered ineffective because of a lack of scientific evidence supporting their effectiveness in people with PLP. Graded motor imagery, mirror therapy, and amitriptyline have been endorsed by most experts because of the available supporting scientific evidence and their reported efficacy in clinical practice. Cognitive Behavioral Therapy, virtual reality training and use of a functional prosthesis have been endorsed by most experts because of their reported effectiveness in clinical practice.
However, this group of experts indicated that there is essentially no scientific evidence supporting the use of these treatments for PLP. The content of the manuscript from which these summarized results were extracted is presented below”.
Manuscript published in Physical Medicine and Rehabilitation
- Abstract
Consensus was reached on the treatments endorsed by 50% or more of the experts. Results: Thirty-seven treatments were proposed for the treatment of PLP at the start of the study. There is some scientific evidence to support the effectiveness of the treatment and the treatment is effective in clinical practice.
37 treatments were proposed for the treatment of PLP at the beginning of the study. Six of the seven treatments endorsed by experts in this study are non-pharmacologically based.
Care priorities for patients with lower limb amputations: A patient Delphi study
Declaration from author and co-authors
- Declaration from author
- Declaration of co-authors
Background and motivation
Involving patients in clinical decision-making promotes patient-centered care that facilitates a partnership between the patient and the caregiver, recognizes the patient as the expert on their condition, and takes into account their values and treatment preferences (264). Involving patients in clinical decision-making has been shown to improve adherence and produce good clinical outcomes, including greater patient satisfaction with clinical care (265, 266).
Aims and objectives
- Aim
- Objectives
Summary of main findings
The participants indicated that mental health, psychological and spiritual well-being is essential for people with amputees. Prevalence and characteristics of long-term phantom limb pain and pain in the rest of the limbs after upper limb amputation. The prevalence of phantom limb pain and associated risk factors in amputees: a systematic review protocol.
Prevalence and risk factors for phantom limb pain in amputees: a systematic review and meta-analysis.
Manuscript prepared for publication in the European Journal of Pain
- Abstract
Conclusion and recommendations
Overview of key findings
Prior to our study, no study had been conducted to determine a robust estimate of the global incidence of PLP. We were also interested in determining whether the prevalence of PLP differs significantly among people with amputations living in developed countries compared to those living in developing countries. Furthermore, these predictors of PLP can be modified and could be used as targets for treatment to prevent or manage PLP.
This prevalence estimate is consistent with the results of the meta-analysis of PLP prevalence studies conducted in developing countries (chapter 2). Similarly, pre-amputation pain was identified as a predictor of PLP, confirming its important role in the onset of PLP in amputees.
Recommendations
- Recommendations for further research
- Recommendations for implementation
Building on the existing promising literature by conducting rigorous randomized control trials investigating the effectiveness of GMI versus sham GMI treatment in reducing chronic PLP and disability in a large and heterogeneous sample of people with amputations. Therefore, incorporating sensory discrimination training into a home program for individuals undergoing GMI or mirror therapy may result in increased treatment effects. Prioritizing the involvement of mental health practitioners (e.g. psychologists, psychiatrists and counsellors) in the interdisciplinary management of people with amputations.
The collaborative effort made by health professionals and relevant stakeholders to address contributors to and consequences of poor mental health can play a significant role in improving the quality of life of people with LLAs. Empowering health care professionals involved in vocational rehabilitation to engage with employers on the effective implementation of strategies necessary for the successful return of people with LLAs to work.
Conclusion
The current evidence suggests that non-pharmacological and non-interventional treatments play an important role in the management of PLP. Although the evidence points us to the effective approach to pain in people with. Our findings on patient-generated care priorities suggest that people with LLAs prioritize being prepared by having access to information and planning support pre-operatively, and getting help with their mental health, and psychological and spiritual well-being during the early post-operative phase , and in the long term they prioritize living a functional and normal life with dignity.
People with amputations endure a traumatic experience of losing a limb and face additional struggles to adjust to a new reality in life thereafter. This research has also provided direction for future work that will help to strengthen health services for people with amputations in Africa.
Effectiveness of graded motor imagery to reduce phantom limb pain in amputees: a randomized controlled trial. Prevalence of phantom limb pain in diabetic and non-diabetic leg amputees: a cross-sectional observational study. Incidence of phantom limb pain, including phantom limb pain, 6 months after major lower limb amputation in patients with peripheral vascular disease.
A randomized controlled trial of mirror therapy for upper extremity phantom limb pain in male amputees. The effectiveness of graded motor imagery for reducing phantom limb pain in amputees: a randomized controlled trial.
Appendices
Ethics study approval letter HREC Ref: 355/2019
Ethics study approval letter HREC Ref: 066/2020
Ethics study approval letter HREC Ref: 771/2020
A systematic review protocol
Acute care surgery online database- HREC 020/2018
Patient information sheet
Sample size calculation
The pain severity scale of the Brief Pain Inventory
Customised assessment sheet for characteristics and risk factors for PLP
Invitation letter to participate as an expert panellist
Information sheet (telephone script)
Consent form
Demographics questionnaire
