Interplay Between Innovation and Intersubjectivity: Therapists Perceptions of Phantom Motor Execution Therapy and Its Effect on Phantom Limb Pain

Abstract

Purpose

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

Acknowledgments

We thank all the therapists who took part in this study.

Disclosure

Professor Max Ortiz-Catalan reports grants from Promobilia Foundation, grants from IngaBritt och Arne Lundbergs Forskningsstiftelse, grants from Swedish Research Council, Consultancy fees from Integrum AB, during the conduct of the study; Consultancy fees from Integrum AB, outside the submitted work; In addition, Professor Max Ortiz-Catalan is an author of the patent but do not own it: EP3082591A4. MOC has consulted for the company that provided the devices used in the PME therapy. The authors declare no other conflicts of interest.