Background & Aims

Graded Motor Imagery (GMI) stands out as a promising treatment for Phantom Limb Pain demonstrating greater pain reduction, compared to mirror therapy [1][2]. Researchers and clinicians endorsed the treatment in a recent Delphi study based on the available evidence and its efficacy in clinical practice [3]. Despite this recognition, a notable gap exists in understanding its real-world implementation. GMI is a complex intervention with multiple components, demanding, a level of expertise for effective delivery in clinical settings. This study used a qualitative method to explore how clinicians implement GMI in their clinical practice. We aimed to identify relevant facilitators, barriers, and considerations for integrating GMI into clinical practice.

Methods

We recruited a cohort of clinicians internationally who had used GMI to treat at least one patient with Phantom Limb Pain within the last 12 months. Participants completed an online demographic questionnaire and semi-structured interviews. Interviews were video and audio recorded, transcribed verbatim and analysed using reflexive thematic analysis.

Results

We interviewed 21 participants and generated four themes that capture their experiences delivering GMI: (1) Powerful tool kit, (2), Structured flexibility, (3) Diverse pathway to expertise, (4) Navigating the complexity of the Phantom, (5) Strategies for success, (6) Accepting limb loss.

Conclusions

This study offers new qualitative insights into the integration of GMI into clinical settings for the treatment of Phantom Limb Pain. Participants shared perspectives on the utility of GMI, the flexibility it provides in treatment approaches, the required clinical experience, and skills, as well as specific barriers and strategies for ensuring effective delivery.

References

[1] Limakatso, K., et al., The effectiveness of graded motor imagery for reducing phantom limb pain in amputees: a randomised controlled trial. Physiotherapy, 2020. 109: p. 65-74.
[2] Bowering, K.J., et al., The effects of graded motor imagery and its components on chronic pain: a systematic review and meta-analysis. J Pain, 2013. 14(1): p. 3-13.
[3] Limakatso, K. and R. Parker, Treatment Recommendations for Phantom Limb Pain in People with Amputations: An Expert Consensus Delphi Study. PM&R, 2021. 13(11): p. 1216-1226.

Presenting Author

Jack Devonshire

Poster Authors

Jack Devonshire, BSc(hons)

BExPhys, BSc(Hons)

University of New South Wales

Lead Author

E-mail

Yannick Gilyani

BExPhys

University of New South Wales

Lead Author

E-mail

Sam Williams

Neuroscience Research Australia

Lead Author

E-mail

Michael Ferraro

BSc(Hons)

University of New South Wales

Lead Author

E-mail

Aidan Cashin

UNSW/Neuroscience Research Australia

Lead Author

E-mail

Rodrigo Rizzo

University of New South Wales

Lead Author

E-mail

Abby Haynes

PhD

Institute for Musculoskeletal Health, The University of Sydney

Lead Author

E-mail

Tim Cocks

Neuro Orthopaedic Institute Australasia (Noigroup)

Lead Author

E-mail

James McAuley

PhD

Neuroscience Research Australia

Lead Author

E-mail

Topics

  • Specific Pain Conditions/Pain in Specific Populations: Pain in Amputees