X-reality for phantom limb management for amputees:A systematic review and meta-analysis

Phantom limb is a disabling neuropsychiatric condition among amputees resulting in pain and disturbance that impact their functions,quality of life,and autonomy.While pharmacological approaches appeared to be ineffec-tive,the emergence and integration of X-reality,including virtual reality,augmented reality,and mixed reality,might elevate the effectiveness of mirror therapy in managing phantom limb.The objective of this study is to review X-reality for managing phantom pain.A systematic search was conducted on PubMed,Scopus,Web of Science,PsycINFO,Embase,and CINAHL.Sixteen(n=16)studies containing 66 lower-limb and 53 upper-limb amputees were included for the review over the thematic framework of amputee characteristics and intervention designs,while thirteen(n=13)studies were further proceeded for the meta-analysis.We found eleven studies on virtual reality(n=11),four studies on marker-based augmented reality(n=4)and one study on mixed reality(n=1)with a total of 40 game/task themes involving,motor skills,motor control,and stimulus-sensing.Regardless,all these interventions adopted the movement representation strategies with different techniques.Overall,the X-reality interventions reduced the pain level of the amputees(mean difference:-2.30,95%CI,-3.38 to-1.22),especially the virtual reality subgroup(mean difference:-2.83,95%CI,-4.43 to-1.22).However,there were substantial heterogeneity and partially explained by the subgroup analysis on publication year.The strength of evidence was limited by case reports and case series in this review.