Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Nov 22;18(22):12240.
doi: 10.3390/ijerph182212240.

Development and Validation of a Graded Motor Imagery Intervention for Phantom Limb Pain in Patients with Amputations (GraMI Protocol): A Delphi Study

Sandra Rierola-Fochs  1 , Luz Adriana Varela-Vásquez  1 , Jose Antonio Merchán-Baeza  1 , Eduard Minobes-Molina  1
Affiliations

Development and Validation of a Graded Motor Imagery Intervention for Phantom Limb Pain in Patients with Amputations (GraMI Protocol): A Delphi Study

Sandra Rierola-Fochs et al. Int J Environ Res Public Health. .

Abstract

Background: Phantom limb pain can be defined as discomfort or pain in a missing part of the limb. The aims of this study were to develop and validate, through a Delphi methodology, a graded motor imagery protocol in order to reduce phantom limb pain.

Method: Physiotherapists and/or occupational therapists with experience in research and a minimum clinical experience of five years in the field of neurorehabilitation and/or pain were recruited by part of a group of experts to assess the intervention. The study was conducted through an online questionnaire, where experts assessed each aspect of the intervention through a Likert scale. As many rounds as necessary were carried out until consensus was reached among experts.

Results: A total of two rounds were required to fully validate the intervention. During the second round, the relative interquartile range of all aspects to be assessed was less than 15%, thus showing a consensus among experts and with good concordance (Kappa index of 0.76).

Conclusion: Experts validated a graded motor imagery intervention of phantom limb pain in patients with amputations (GraMi protocol). This intervention can help to homogenize the use of graded motor imagery in future studies and in clinical practice.

Keywords: amputee; graded motor imagery; pain; phantom limb; treatment.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Study flow and objectives.
Figure 2
Figure 2
Sequence and progression of the intervention.
See this image and copyright information in PMC

References

    1. Zaheer A., Malik A.N., Masood T., Fatima S. Effects of phantom exercises on pain, mobility, and quality of life among lower limb amputees; a randomized controlled trial. BMC Neurol. 2021;21:416. doi: 10.1186/s12883-021-02441-z. - DOI - PMC - PubMed
    1. Batsford S., Ryan C.G., Martin D.J. Non-pharmacological conservative therapy for phantom limb pain: A systematic review of randomised controlled trials. Physiother. Theory Pract. 2017;33:173–183. doi: 10.1080/09593985.2017.1288283. - DOI - PubMed
    1. Bowering K.J., O’Connell N., Tabor A., Catley M., Leake H.B., Moseley L., Stanton T. The Effects of Graded Motor Imagery and Its Components on Chronic Pain: A Systematic Review and Meta-Analysis. J. Pain. 2013;14:3–13. doi: 10.1016/j.jpain.2012.09.007. - DOI - PubMed
    1. García-pallero M.Á., Cardona D., Rueda-ruzafa L. Central nervous system stimulation therapies in phantom limb pain: A systematic review of clinical trials. Neural. Regen. Res. 2022;17:59–64. - PMC - PubMed
    1. Makin T.R. Phantom limb pain: Thinking outside the (mirror) box. Brain. 2021;144:1929–1932. doi: 10.1093/brain/awab139. - DOI - PMC - PubMed

Publication types