Treating Lower Phantom Limb Pain in the Postoperative Acute Care Setting Through a Virtual Reality-Based Graded Motor Imagery Program: A Case Series.

Background: Phantom limb pain (PLP) affects over 70% of people with lower limb amputations (LLAs). Graded motor imagery (GMI) is an established nonpharmacological treatment that targets the cortical mechanisms associated with PLP onset and may be the most effective if it is administered shortly following amputation. However, application of GMI in practice is hindered by the need for trained health care professionals to assist with longitudinal administration and by low patient buy-in (i.e., one's understanding of, and motivation to engage in, a treatment modality). To address these barriers, our research team developed a virtual reality (VR) program to facilitate self-administration of GMI. Objectives: The primary objective of the current case series was to assess initial feasibility of using the VR GMI program in the acute postoperative setting by evaluating recruitment trends. The secondary objective was to describe the satisfaction, usability, and tolerability of the VR GMI program after short-term administration. Methods: Patients undergoing LLAs at a single academic tertiary hospital were screened for eligibility and interest, and consenting individuals underwent daily sessions in the VR GMI program. Adverse events (i.e., any instance in which pain or nausea interrupted VR engagement, as indicated by the Numerical Rating Scale) were monitored to evaluate tolerability. A self-report questionnaire assessed satisfaction and usability. Results: Of 52 individuals screened, 41 were not eligible to participate (79%). Five eligible individuals were not interested in participating due to feeling overwhelmed (10%). Six participants were recruited (12%), and four were able to complete the entire intervention before their hospital discharge (8%). Most participants rated the program as easy to understand, enjoyable, and helpful. However, participant scores also indicated the need to improve usability. Only one participant reported an adverse event (i.e., fatigue in phantom limb). Conclusions: These results will directly inform refinement of the VR GMI prototype and related VR research implemented in the postoperative setting.