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The effect of targeted muscle reinnervation on post-amputation pain and functional outcomes: a systematic review and meta-analysis

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Abstract

Background

Targeted muscle reinnervation (TMR) has been shown to reduce phantom limb pain (PLP) and residual limb pain (RLP) in amputee patients, improving the quality of life. This systematic review aimed to evaluate the quality of data and determine the efficacy of TMR on pain reduction and functional outcomes in amputees.

Methods

The protocol was registered and published a priori on PROSPERO (CRD42021285083). Medline, Embase, CENTRAL, Science Citation Index, and PsycINFO databases were searched until June 2022, retrieving 10 studies (n = 943). Selected outcomes were pain scores, improvement in limb function, complication rates, pain medication, and resubmission rates.

Results

Ten studies (1 RCT and 9 observational studies) were included (n = 1099 limbs). The mean follow-up was 17.9 months (range 9.6–24.0). For NRS, the pooled mean difference was − 2.68 (95% CI: − 3.21, − 2.14; p < 0.0001) for RLP and − 2.17 (95% CI: − 2.70, − 1.63; p < 0.0001) for PLP, in favor of the TMR group, respectively. Pooled mean differences were significantly lower for all domains (all p < 0.0001) of the PROMIS score, in favor of the TMR group. Complication rates ranged from 0 to 16%. All studies showed a reduction in PLP and RLP following TMR. Three studies, assessing functional outcomes, showed an increase following TMR. The RCT was graded high quality and observational studies were moderate to very low quality.

Conclusions

Despite varying study quality, pooled analysis shows a significant reduction in RLP and PLP across all PROMIS domains and significant reduction in NRS scores in the TMR group. Additionally, TMR demonstrated improved functional outcomes for amputees.

Systematic review registration.

PROSPERO CRD42021285083.

Level of evidence: Not gradable

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The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

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Authors and Affiliations

  1. Wrightington, Wigan and Leigh Teaching Hospitals NHS Foundation Trust, Wigan, UK

    Jun-Li Tham

  2. GKT School of Medical Education, King’s College London, London, UK

    Avnish Sood

  3. Department of Plastic and Reconstructive Surgery, The Ohio State University, Columbus, OH, USA

    Tiam Mana Saffari

  4. Division of Hand and Microvascular Surgery, Department of Orthopaedic Surgery, Mayo Clinic, Rochester, MN, USA

    Tiam Mana Saffari

  5. Department of Surgery and Cancer, Imperial College London, London, UK

    Ankur Khajuria

  6. Kellogg College, University of Oxford, Oxford, UK

    Ankur Khajuria

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All authors contributed to the idea and design of this review, drafting the article, and revising it critically. They are all in approval of the version submitted and agree to be accountable for all aspects of the work if questions arise related to its accuracy or integrity.

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Tham, JL., Sood, A., Saffari, T.M. et al. The effect of targeted muscle reinnervation on post-amputation pain and functional outcomes: a systematic review and meta-analysis. Eur J Plast Surg 46, 475–497 (2023). https://doi.org/10.1007/s00238-022-02021-5

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