Promobilia Foundation, VINNOVA, Jimmy Dahlstens Fond, PicoSolve, and Innovationskontor Väst.

IntroductionPhantom limb pain (PLP) is a chronic condition that can greatly diminish quality of life. Control over the phantom limb and exercise of such control have been hypothesised to reverse maladaptive brain changes correlated to PLP. Preliminary investigations have shown that decoding motor volition using myoelectric pattern recognition, while providing real-time feedback via virtual and augmented reality (VR-AR), facilitates phantom motor execution (PME) and reduces PLP. Here we present the study protocol for an international (seven countries), multicentre (nine clinics), double-blind, randomised controlled clinical trial to assess the effectiveness of PME in alleviating PLP.Methods and analysisSixty-seven subjects suffering from PLP in upper or lower limbs are randomly assigned to PME or phantom motor imagery (PMI) interventions. Subjects allocated to either treatment receive 15 interventions and are exposed to the same VR-AR environments using the same device. The only difference between interventions is whether phantom movements are actually performed (PME) or just imagined (PMI). Complete evaluations are conducted at baseline and at intervention completion, as well as 1, 3 and 6 months later using an intention-to-treat (ITT) approach. Changes in PLP measured using the Pain Rating Index between the first and last session are the primary measure of efficacy. Secondary outcomes include: frequency, duration, quality of pain, intrusion of pain in activities of daily living and sleep, disability associated to pain, pain self-efficacy, frequency of depressed mood, presence of catastrophising thinking, health-related quality of life and clinically significant change as patient’s own impression. Follow-up interviews are conducted up to 6 months after the treatment.Ethics and disseminationThe study is performed in agreement with the Declaration of Helsinki and under approval by the governing ethical committees of each participating clinic. The results will be published according to the Consolidated Standards of Reporting Trials guidelines in a peer-reviewed journal.Trial registration numberNCT03112928; Pre-results.

Background:Prostheses are used to varying degrees; however, little is known about how environmental aspects influence this use.Objectives:To describe users’ experiences of how environmental factors influence their use of a myoelectric arm prosthesis.Study design:Qualitative and descriptive.Methods:A total of 13 patients previously provided with a myoelectric prosthetic hand participated. Their age, sex, deficiency level, etiology, current prosthesis use, and experience varied. Semi-structured interviews were audiotaped, transcribed, and analyzed through inductive content analysis.Results:Four categories were created from the data: “Prosthesis function,” “Other people’s attitudes,” “Support from family and healthcare,” and “Individual’s attitude and strategies.” The overarching theme, “Various degrees of embodiment lead to different experiences of environmental barriers and facilitators,” emerged from differences in individual responses depending on whether the individual was a daily or a non-daily prosthesis user. Environmental facilitators such as support from family and healthcare and good function and fit of the prosthesis seemed to help the embodiment of the prosthesis, leading to daily use. This embodiment seemed to reduce the influence of environmental barriers, for example, climate, attitudes, and technical shortcomings.Conclusion:Embodiment of prostheses seems to reduce the impact of environmental barriers. Support and training may facilitate the embodiment of myoelectric prosthesis use.Clinical relevanceFor successful prosthetic rehabilitation, environmental factors such as support and information to the patient and their social network about the benefits of prosthesis use are important. Local access to training in myoelectric control gives more people the opportunity to adapt to prosthesis use and experience less environmental barriers.

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Objective: To evaluate the effect of multi-grip myoelectric prosthetic hands on performance of daily activities, pain-related disability and prosthesis use, in comparison with single-grip myoelectric prosthetic hands. Design: Single-case AB design. Patients: Nine adults with upper-limb loss participated in the study. All had previous experience of single-grip myoelectric prostheses and were prescribed a prosthesis with multi-grip functions. Methods: To assess the changes in daily activities, pain-related disability and prosthesis use between single-grip and multi-grip myoelectric prosthetic hands, the Canadian Occupational Performance Measure, Pain Disability Index, and prosthesis wearing time were measured at multiple time-points. Visual assessment of graphs and multi-level linear regression were used to assess changes in the outcome measures. Results: At 6 months’ follow-up self-perceived performance and satisfaction scores had increased, prosthesis wearing time had increased, and pain-related disability had reduced in participants with musculoskeletal pain at baseline. On average, 8 of the 11 available grip types were used. Most useful were the power grip, tripod pinch and lateral pinch. Conclusion: The multi-grip myoelectric prosthetic hand has favourable effects on performance of, and satisfaction with, individually chosen activities, prostheses use and pain-related disability. A durable single-grip myoelectric prosthetic hand may still be needed for heavier physical activities. With structured training, a standard 2-site electrode control system can be used to operate a multi-grip myoelectric prosthetic hand.