Abstract
Objectives
To investigate the efficacy of the use of mirror visual feedback in patients with phantom limb pain following amputation applying numerical rating scale.
Methodology
It was a quasi-experimental study carried out in Armed Forces Institute of Rehabilitation Medicine (AFIRM), Rawalpindi from January 2013 to June 2013. Through non-probability consecutive sampling, male amputee patients diagnosed with phantom limb pain unresponsive to six months of medical management were included. The sample was divided into traumatic and non-traumatic groups based on etiology and given therapy in a quiet room placing amputated limb behind an 8 x 5 feet mirror positioned in a way that the reflection of the intact limb was superimposed on the amputated limb. The patients performed exercises with their unaffected limb for 15 minutes daily. The severity of pain was recorded using numerical rating scale at initial presentation and at first (Phase-1), second (Phase-2) and third (Phase-3) week of therapy. The mean reduction in pain in the whole sample and among the groups was analyzed by paired sample t-test/Wilcoxon signed-rank test where appropriate. A p-value < 0.05 was considered significant
Results
Of 35 male patients (age: 36 ± 11, range 17 - 60 years), 27 had a traumatic and 8 had a non-traumatic etiology to their amputation. The mean pain intensity measured was (7.9 ± 1.14, range: 6 - 10) at initial presentation and (6.9 ± 1.1, range: 5 – 9), (4.4 ± 1.1, range: 2 – 7) and (1.1 ± 0.93, range: 0 – 3) after Phase-1, Phase-2 and Phase-3 respectively. The mean pain intensity was significantly reduced at the end of all phases in the whole sample (p< 0.001, p< 0.001, p< 0.001 respectively) as well as in group-A (p=0.001, p<0.001, p<0.001 respectively) and Group-B (p=0.039, p=0.01, p=0.01 respectively)
Conclusion
Mirror visual feedback is an effective modality to treat phantom limb pain in amputee patients irrespective of the etiology of amputation. The promising results are achieved within a week of treatment and significantly improve further over the next two weeks.

Key words: Amputees, Mirror visual feedback, Pakistan armed forces, Phantom limb pain.