Clinician perspectives on postamputation pain assessment and rehabilitation interventions

Tonya L Rich; Kierra J Falbo; Hannah Phelan; Amy Gravely; Erin E Krebs; Jacob A Finn; Mary Matsumoto; Katherine Muschler; Christine M Olney; Jessica Kiecker; Andrew H Hansen

doi:10.1097/PXR.0000000000000284

Clinician perspectives on postamputation pain assessment and rehabilitation interventions

Prosthet Orthot Int. 2023 Oct 3. doi: 10.1097/PXR.0000000000000284. Online ahead of print.

Authors

Tonya L Rich^{1

2}, Kierra J Falbo^{2

3}, Hannah Phelan^{3

4}, Amy Gravely³, Erin E Krebs^{5

6}, Jacob A Finn^{1

7}, Mary Matsumoto^{1

8}, Katherine Muschler³, Christine M Olney^{2

3

9}, Jessica Kiecker¹, Andrew H Hansen^{1

2

10}

Affiliations

¹ Department of Rehabilitation & Extended Care, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, USA.
² Division of Rehabilitation Science, Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, MN, USA.
³ Department of Research, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, USA.
⁴ Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
⁵ Division of General Internal Medicine, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, USA.
⁶ Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA.
⁷ Department of Psychiatry & Behavioral Sciences, University of Minnesota, Minneapolis, MN, USA.
⁸ Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, MN, USA.
⁹ School of Nursing, University of Minnesota, Minneapolis, MN, USA.
¹⁰ Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN, USA.

PMID: 37791790
DOI: 10.1097/PXR.0000000000000284

Abstract

Objective: The purpose of this study was to explore self-reported Veterans Affairs (VA) amputation clinician perspectives and clinical practices regarding the measurement and treatment for amputation-related pain.

Study design: Cross-sectional survey with 73 VA rehabilitation clinicians within the VA Health Care System.

Results: The most frequent clinical backgrounds of respondents included physical therapists (36%), prosthetists (32%), and physical medicine and rehabilitation specialist (21%). Forty-one clinicians (56%) reported using pain outcome measures with a preference for average pain intensity numeric rating scale (generic) (97%), average phantom limb pain intensity numeric rating scale (80%), or Patient-Reported Outcomes Measurement Information System pain interference (12%) measures. Clinicians' most frequently recommended interventions were compression garments, desensitization, and physical therapy. Clinicians identified mindset, cognition, and motivation as factors that facilitate a patient's response to treatments. Conversely, clinicians identified poor adherence, lack of belief in interventions, and preference for traditional pain interventions (e.g., medications) as common barriers to improvement. We asked about the frequently used treatment of graded motor imagery. Although graded motor imagery was originally developed with 3 phases (limb laterality, explicit motor imagery, mirror therapy), clinicians reported primarily using explicit motor imagery and mirror therapy.

Results: Most clinicians who use standardized pain measures prefer intensity ratings. Clinicians select pain interventions based on the patient's presentation. This work contributes to the understanding of factors influencing clinicians' treatment selection for nondrug interventions. Future work that includes qualitative components could further discern implementation barriers to amputation pain rehabilitation interventions for greater consistency in practice.