| Abstract | Phantom limb syndrome (PLSd) is a prevalent complication post amputation which can
be severe and chronic. Multi-disciplinary treatment is recommended, addressing
peripheral, central and psychological factors. Although acupuncture is recommended,
evidence supporting its effectiveness is sparse. This project aimed to develop an
acupuncture protocol for the treatment of lower limb amputees with PLSd and evaluate
its acceptability and feasibility prior to a definitive trial.
The project was situated under the Medical Research Council’s framework for
developing and evaluating complex interventions, and used a multiphase mixed
methods research design. Three systematic literature reviews and two studies were
undertaken to inform a feasibility study. The literature reviews aimed to identify
previous research undertaken on the experience and management of PLSd. The first
study, a Delphi study, aimed to develop an acupuncture protocol and the second, a
qualitative descriptive study, explored amputees’ perceived acceptability of
acupuncture within the context of living with PLSd. From these findings a feasibility
study was designed and conducted, comprising a randomised controlled trial and semistructured
interviews.
The literature reviews identified limited qualitative studies exploring amputees’
experience of PLSd, limited evidence supporting interventions for PLSd and only two
non-randomised controlled trials evaluating the effectiveness of acupuncture for
treating PLSd. The Delphi study developed a novel acupuncture protocol which was
considered ‘good practice’ and this was used in the feasibility study. The qualitative
descriptive study produced rich data, not previously available on a UK demographic
group of amputees shortly post amputation, on their experience of PLSd. PLSd was
found to be ‘real’ and bothersome with effects on wellbeing. Additionally, acupuncture
was perceived acceptable and outcome measures were identified for use in the
feasibility study. The feasibility study generated new original findings on areas which
would need addressing before undertaking a definitive trial, including; problems with
recruitment, completion of outcomes at one month follow up, blinding, practitioner
adherence to the acupuncture protocol, capture of rescue medication and recording of adverse events. Acupuncture was perceived to be effective at resolving or reducing
PLSd.
Findings from this project could inform the development of a definitive trial to establish
the effectiveness of acupuncture for treating PLSd. |
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