Work Type



Fall 2017

Faculty Advisor

Dr. Roger Allen




Authors: Garrett B Hoskins, SPT; Erick T Moon, SPT; Roger J. Allen, PT, PhD

Mirror visual feedback therapy for treatment of phantom limb pain: a clinical practice guideline.

Purpose: A growing number of recent controlled studies report mirror visual feedback therapy (MT) holds promise for treatment of phantom limb pain (PLP) following amputation, via facilitation of neuroplastic cortical remodeling. However, available research reports typically do not contain sufficient detail regarding the MT components utilized to allow clinicians to implement protocols found to be effective. The purpose of this study was to synthesize a clinical practice guideline, based on a systematic review of current MT research, that articulates the components, dosing, and parameters of efficacious MT protocols for PLP intervention.

Number of Subjects: Twenty quantitative studies from peer-reviewed journals were reviewed. All studies included MT as a treatment intervention and used at least one pain outcome measure pertaining to PLP. Studies not available as full text or not accessible in English were excluded.

Methods: CINAHL, Cochran Library, Google Scholar and PubMed were searched between Jan 2016-Feb 2017 for "phantom limb pain," and/or "mirror therapy". Systematic reviews, randomized control trials, controlled pilot studies, and controlled and uncontrolled case series were reviewed. A compendium was established of MT treatment intervention components utilized, frequency and settings of practice, outcome measures and adverse reactions, with cross-study efficacy comparisons to determine viable MT elements. When published studies contained insufficient detail on MT intervention, principle investigators were contacted by email with requests for additional information on treatment details and dosing.

Results: Among the 20 studies reviewed, MT was used as the primary treatment for PLP. MT was frequently preceded by laterality training and graded motor imagery. Effective treatment components utilized during MT sessions included multifaceted somatosensory stimulation, distal movements, and functional activities. MT was found effective whether via direct therapist supervision in-clinic or with therapist-designed activities conducted as home programs. A comprehensive clinical practice guideline was synthesized for presentation, based on positive outcome measures regarding pain and clinical usefulness.

Conclusions: Current literature shows that MT can significantly reduce pain and improve pain-related function in patients with PLP. Treatment elements found to be effective in controlled studies have afforded synthesis of a comprehensive clinical practice guideline for implementation of MT by therapists treating PLP.

Clinical Relevance: MT efficacy literature has established the viability of MT as a treatment for PLP, however, lack of sufficient published detail regarding components and parameters of treatment left therapists at a loss as to how to most effectively implement MT with patients. This clinical practice guideline helps therapists easily implement mirror therapy; rendering a more thorough and effective plan of care for patients with PLP.

Keywords: phantom limb pain, graded motor imagery, mirror therapy


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University of Puget Sound