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Treatment Recommendations for Phantom Limb Pain in People with Amputations: An Expert Consensus Delphi Study
Author(s) -
Limakatso Katleho,
Parker Romy
Publication year - 2021
Publication title -
pmandr
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.617
H-Index - 66
eISSN - 1934-1563
pISSN - 1934-1482
DOI - 10.1002/pmrj.12556
Subject(s) - medicine , delphi method , medline , scientific evidence , delphi , evidence based medicine , evidence based practice , physical therapy , physical medicine and rehabilitation , psychology , alternative medicine , computer science , philosophy , epistemology , pathology , artificial intelligence , political science , law , operating system
Background Phantom limb pain (PLP) is common and often accompanied by serious suffering. Current systematic‐review evidence suggests that recommended treatments are no more effective than placebo for reducing PLP. Given the difficulty in conducting a meta‐analysis for nonpharmacological treatments and the weak evidence for pharmacological treatments for PLP, consensus on the first‐line management of PLP needs to be reached using alternative methods. Objective To reach expert consensus and make recommendations on the effective management of PLP. Design A three‐round Delphi design was used. Setting The study was conducted using e‐mail and Google survey tool as the main methods of communication and providing feedback. Participants The study included 27 clinicians and researchers from various health disciplines who are experts in PLP management. Method Data were collected using three sequential rounds of anonymous online questionnaires where experts proposed and ranked the treatments for PLP. A consensus was reached on the treatments that were endorsed by 50% or more of the experts. Results Thirty‐seven treatments were proposed for the management of PLP at the beginning of the study. Consensus was reached on seven treatments that were considered effective for managing PLP and on two treatments that were considered ineffective. Graded motor imagery, mirror therapy, amitriptyline, sensory discrimination training, and use of a functional prosthesis were endorsed by most experts because of the available backing scientific evidence and their reported efficacy in clinical practice. Cognitive behavioral therapy and virtual reality training were endorsed by most experts because of their reported efficacy in clinical practice despite indicating a dearth of scientific evidence to support their ranking. Citalopram and dorsal root ganglion pulsed radiofrequency were rejected owing to a lack of relevant scientific evidence. Conclusion The results of this study suggest that the nonpharmacological treatments endorsed in this study may have an important role in the management of PLP.