Journal of Pain Research (Aug 2023)
Interplay Between Innovation and Intersubjectivity: Therapists Perceptions of Phantom Motor Execution Therapy and Its Effect on Phantom Limb Pain
Abstract
Monika Pilch,1 Tijn van Rietschoten,2,3 Max Ortiz-Catalan,4– 6 Eva Lendaro,6,7 Corry K van der Sluis,2 Liselotte Hermansson8,9 1Centre for Health Policy & Management, School of Medicine, Trinity College Dublin, Dublin, Ireland; 2University of Groningen, University Medical Center Groningen, Department of Rehabilitation Medicine, Groningen, the Netherlands; 3University of Groningen, Faculty of Medical Sciences, Groningen, the Netherlands; 4Center for Bionics and Pain Research, Mölndal, Sweden; 5Bionics Institute, Melbourne, VC, Australia; 6Department of Electrical Engineering, Chalmers University of Technology, Gothenburg, Sweden; 7Department of Brain and Cognitive Sciences, McGovern Institute for Brain Research, Massachusetts Institute of Technology, Cambridge, MA, USA; 8Department of Prosthetics and Orthotics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden; 9University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, SwedenCorrespondence: Monika Pilch, Centre for Health Policy and Management, School of Medicine, Trinity College Dublin, 3-4 Foster Place, Dublin, Ireland, Tel + 353 851614350, Email [email protected] Corry K van der Sluis, University of Groningen, University Medical Center Groningen, Department of Rehabilitation Medicine, Groningen, the Netherlands, Tel + 31 503612295, Email [email protected]: Interpersonal processes, including therapeutic alliance, may modulate the impact of interventions on pain experience. However, the role of interpersonal context on the effects of technology-enhanced interventions remains underexplored. This study elicited therapists’ perspectives on how a novel rehabilitative process, involving Phantom Motor Execution (PME), may impact phantom limb pain. The mediating role of therapeutic alliance, and the way PME influenced its formation, was investigated.Methods: A qualitative descriptive design, using a framework method, was used to explore therapists’ (n=11) experiences of delivering PME treatment. Semi-structured online-based interviews were conducted.Results: A 3-way interaction between therapist, patient, and the PME device was an overarching construct tying four themes together. It formed the context for change in phantom limb experience. The perceived therapeutic effects (theme 1) extended beyond those initially hypothesised and highlighted the mediating role of the key actors and context (theme 2). The therapeutic relationship was perceived as a transformative journey (theme 3), creating an opportunity for communication, collaboration, and bonding. It was seen as a cause and a consequence of therapeutic effects. Future directions, including the role of expertise-informed adaptations and enabling aspects of customised solutions, were indicated (theme 4).Conclusion: This study pointed to intrapersonal, interpersonal, and contextual factors that should be considered in clinical implementation of novel rehabilitative tools. The results demonstrated that therapists have unique insights and a crucial role in facilitating PME treatment. The study highlighted the need to consider the biopsychosocial model of pain in designing, evaluating, and implementing technology-supported interventions.Keywords: phantom limb experience, pain, rehabilitation, therapeutic alliance, innovation
