Background & Aims
Body Perception Disturbances (BPD) are common in patients with Chronic Limb Pain (CLP), correlate with pain intensity, and negatively affect rehabilitation outcomes and quality of life. Numerous BPD tools exist, mainly the Bath-BPD and the Neurobehavioral questionnaires, exploring the cognitive and motor aspects of BPD. However, a standard test revealing the visual perception aspects of BPD, namely distortion in limb size and position and satisfaction with limb appearance, using a quantifiable measure has not been reported. Bridging this gap, we developed The Visual Limb Distortion Test (VLDT) – a pictorial test reflecting the patient’s perception of limb size and position. The study aimed to evaluate the VLDT’s face validity, explore patterns of visual limb representation, and test their temporal stability. Additionally, we aimed to test the patient’s perspective and satisfaction with his/her painful limb using quantitative and qualitative analysis methods.
Methods
The VLDT comprises 13 man/woman silhouettes that differ in limb (hand/foot) size (%) and position (angles°), with a gradual increase/decrease of 20% in size and position, respectively. By selecting the current and desired silhouette, the final score reflects the patient’s perceptual disturbances severity. Additionally, we used a 10-point limb satisfaction questionnaire to test satisfaction with the painful limb appearance as well as an open question asking patients to describe their feelings towards it. This research comprised two stages: i) test construction and development, utilizing patients and therapists as an advisory expert panel.; and ii) exploration of visual limb and body perception patterns, their temporal stability, level of satisfaction, and feelings towards the limb. All participants were diagnosed based on Budapest criteria and evaluated by a pain specialist physician using the Complex Regional Pain Syndrome (CRPS) severity score.
Results
The first phase included 12 pain-specialized therapists and 11 CLP patients, serving as an expert panel, confirming the VLDT face validity. Based on the panel reviews, the test was adapted and refined. In the second phase, participants comprised 20 (60% females) CLP patients (7 CRPS, 13-CRPS not otherwise specified), aged [mean (SD) 37.2 (12.6)]. Findings indicate selective distortion in the visual representation of the painful compared to the nonpainful limb; more participants perceived their limb as larger (n=12, average 40% increase) than smaller (n=6, average 65% decrease). Only 10% (n=2) perceived both limbs as equal in size. Retesting the perceived limb size and position one week apart indicated temporal consistency (rs=.92, p=.003). Moreover, satisfaction with limb appearance was low [mean (SD) 3.5 ± (3.06)], and mostly accompanied by strong negative emotions towards the painful limb.
Conclusions
Using the VLDT, we can answer important questions regarding different aspects of body/ limb perception in CLP patients, namely appearance satisfaction, emotional relation, perceived limb image, and its stability/ malleability over time. Our preliminary results indicate selective unilateral limb distortion accompanied by heterogeneity in limb size representation with a trend toward enlargement of the painful limb. Additionally, lower appearance satisfaction and an allocentric view of the painful limb were also evident, implying depersonalization processes. The study’s next stage will focus on identifying the psychophysics and emotional mechanisms associated with negative perception of appearance and distorted representation of the painful limb and its relation to pain intensity and daily function disability.
References
Buckelew, S. P., Huyser, B., Hewett, J. E., Johnson, J. C., Conway, R., Parker, J. C., & Kay, D. R. (1996). Self?efficacy predicting outcome among fibromyalgia subjects. Arthritis & Rheumatism: Official Journal of the American College of Rheumatology, 9(2), 97-104.?
Miró, E., Martínez, M. P., Sánchez, A. I., Prados, G., & Medina, A. (2011). When is pain related to emotional distress and daily functioning in fibromyalgia syndrome? The mediating roles of self?efficacy and sleep quality. British journal of health psychology, 16(4), 799-814.?
Sarzi-Puttini, P., Giorgi, V., Marotto, D., & Atzeni, F. (2020). Fibromyalgia: an update on clinical characteristics, aetiopathogenesis and treatment. Nature Reviews Rheumatology, 16(11), 645-660.?
Toglia, J., Foster, E., & Jethani, P. (2020). Cognitive Self-Efficacy in Parkinson’s Disease (PD). American Journal of Occupational Therapy, 74.?
Presenting Author
Tami Bar-Shalita
Poster Authors
Hana Karpin
PhD OT
Tel Aviv University
Lead Author
Anatoly Livshitz
Reuth Rehabilitation Hospital
Lead Author
Hadas Gotlib
Reuth Rehabilitation Hospital
Lead Author
Floretta Aharonovich
Reuth Rehabilitation Hospital
Lead Author
Tami Bar-Shalita
Tel-Aviv University
Lead Author
Topics
- Specific Pain Conditions/Pain in Specific Populations: Complex Regional Pain Syndrome (CRPS)