Background & Aims
Lower limb amputation has an estimated worldwide prevalence of 35.3 million people. Many aspects influence the quality of life of amputees, but key features to consider are Phantom Limb Pain (PLP) and Phantom Limb Sensations (PLS). While PLP and PLS integrate the clinical spectrum of amputee patients, both are also reported to have differences in the central, peripheral and psychological adaptation processes, therefore the consideration of these both aspects are essential when it comes to study patients with amputation. However, up to today, there are not enough clinical tools integrating PLP-PLS in the clinical-therapeutic decision-making of amputee patients with PLP. This study intends to test the PLP-PLS index as a clinical and therapeutic sub-phenotype tool in Phantom Limb Pain patients.
Methods
We conducted a cross-sectional baseline study of 112 patients from one of the largest mechanistic clinical trials investigating amputees with lower limb amputation and PLP. As a primary analysis, it was performed a univariate linear regression analysis followed by an iterative forward selection process to generate a multivariate linear regression model. A secondary analysis was conducted using a logistic regression model with the PLP-PLS index as a categorical variable, and e-value calculation for the most significant variables observed in regression models was performed as a sensitivity analysis.
Results
For the primary analysis, time since amputation (?: 0.0056; CI: 0.00068 – 0.1058; P=0.026); negative predictors – movement (?:-1.338; CI: -2.384 to -0.2920; P=0.013) and anxiety (?: – 0.0548; CI: -0.0548 to -0.0002; P=0.049) were found as positive predictors. The secondary analysis showed the side of amputation (OR: 2.19; CI: 1.010615- 4.748628), PLS- cold (OR: 2.11; CI: 0.8683393-5.154894) time since amputation (OR: 1.003; CI: 0.9995063-1.007142), anxiety (OR: 0.9612169; CI:0.924029-0.9999014), and PLS-movement (OR: 0.5294118; CI: 0.2441955-1.147756) as significant variables. E-value was estimated for movement (coef.-1.53, SE 0.55).
Conclusions
In this study, we demonstrated an association of the PLP-PLS Index with phantom limb sensation related to movement and anxiety, which might represent the potential of the PLP_PLS Index as an explanatory tool of compensatory sensorimotor adaptation in patients with lower limb amputations. However, the PLP-PLS index should be tested in further studies in pre-post intervention to make further assumptions of the index as a clinical sub-phenotype tool in patients with phantom limb pain.
References
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Presenting Author
Kevin Pacheco-Barrios
Poster Authors
Kevin Pacheco-Barrios
MD, MPH, MSc
Spaulding Rehabilitation Hospital, Harvard Medical School.
Lead Author
Jorge Ortega Márquez
Spaulding Rehabilitation Hospital, Harvard Medical School.
Lead Author
Justyna Garnier
Principal and practice of clinical research program, Harvard TH Chan School of Public Health.
Lead Author
Lucas Mena
Principal and practice of clinical research program, Harvard TH Chan School of Public Health.
Lead Author
Ana Victoria Palagi Vigano
Principal and practice of clinical research program, Harvard TH Chan School of Public Health.
Lead Author
Eleonora Boschetti Grützmacher
Principal and practice of clinical research program, Harvard TH Chan School of Public Health.
Lead Author
Gabriel Vallejos-Penaloza
Principal and practice of clinical research program, Harvard TH Chan School of Public Health.
Lead Author
Daniela Martinez Magallanes
Spaulding Rehabilitation Hospital, Harvard Medical School.
Lead Author
Valton Costa
Spaulding Rehabilitation Hospital, Harvard Medical School.
Lead Author
Antonio Vaz de Macedo
Principal and practice of clinical research program, Harvard TH Chan School of Public Health.
Lead Author
Waynice Neiva de Paula-Garcia
Principal and practice of clinical research program, Harvard TH Chan School of Public Health.
Lead Author
Denise Saretta Schwartz
Principal and practice of clinical research program, Harvard TH Chan School of Public Health.
Lead Author
Felipe Fregni
Spaulding Rehabilitation Hospital, Harvard Medical School.
Lead Author
Topics
- Mechanisms: Psychosocial and Biopsychosocial