Comparative evaluation of the efficacy of five PRM programmes on functional autonomy and phantom pain in patients after lower limb amputation

Abstract

Our objective was to realize a comparative evaluation of five PRM programmes of care in patients after transfemoral amputation. During last years a total of 105 amputees were observed and investigated - in-patients of the Clinic/Department of Physical and Rehabilitation Medicine (PRM). Patients were randomized into five treatment groups consisting of 21 patients each. All patients received a transfemoral amputation 1 to 6 months before rehabilitation, with stump pain and phantom pain. All patients gave written informed consent. All patients received a complex rehabilitation programme including physical therapy and patients’ education. We accentuate on: analytic exercises for hip muscles, post-isometric relaxation for ilio-psoas muscle, strengthening exercises for the paravertebral and abdominal muscles; balance and gait training. In group 1 we applied too drug therapy - paravertebral infiltrations. Patients of groups 2 & 3 received a complex rehabilitation programme, including a preformed physical modality [Deep Oscillation (DO) or LASER]. In groups 4 and 5 we applied combined analgesic techniques (gr 4 = infiltrations and DO, gr 5 = infiltrations and laser). For statistical evaluation we used t -test (ANOVA) and Wilcoxon rank test (non-parametrical correlation analysis), performed using SPSS package (statistical significance - if P -value < 0.05). The comparative analysis of results shows a significant improvement of the symptoms of the patients, concerning: quality of life and functional autonomy (Mc Gill quality of life questionnaire); pain (Visual analogue scale, faces scale and evaluation of stump tenderness), and depression (scale of Zung). Best results were obtained in groups 4 and 5. We could recommend the complex program for functional recovery of amputees.