# Home-based rehabilitation intervention for phantom limb pain in Veterans with lower limb amputations

> **NIH VA IK2** · MINNEAPOLIS VA  MEDICAL CENTER · 2024 · —

## Abstract

Phantom Limb Pain (PLP) is a form of unpredictable neuropathic pain in Veterans with
amputation. Current non-medication treatments for PLP are limited and more
interventions are needed that take into consideration the unique needs of the Veteran
population. PLP significantly impairs rehabilitation outcomes and community
participation. One non-medication intervention is graded motor imagery (GMI). GMI
consists of sequentially progressing from limb laterality training, to motor imagery, and
then mirror therapy (i.e., observing movement using the visual illusion of an intact limb
in a mirror). Although clinicians report benefit from use of the technique, barriers exist to
supporting at-home use of the intervention. This VA Career Development Award-2
proposal focuses on refining a mobile app for GMI (VA-GMI) and then testing serial
sessions of mobile app use in a sample of Veterans with lower limb amputation and
moderate to severe PLP in their home setting.
We have a current working prototype of the VA-GMI mobile app. The project will initially
include serial cognitive interviews with 12 Veterans with lower limb amputation and PLP
as they trial the VA-GMI mobile app. Following each interview, we will compile the
themes and make iterative changes to improve the user interface and functionality of
the mobile app. We will then invite the Veterans to try the new version over the course
of a week and repeat the process. We anticipate that we can reach consensus on the
improvements to VA-GMI mobile app within 2 major iterations.
In years 2-5, we will conduct a pilot study to evaluate the feasibility and acceptability of
the intervention with 36 Veterans with amputation and moderate to severe PLP. We will
conduct this study virtually with all Veterans in their home environment. All Veterans will
receive twelve intervention sessions. To allow for real-time observation and assistance
with VA-GMI mobile app, we will use existing telehealth platforms to visualize and
interact with the Veteran. The primary outcome measure is the Acceptability of
Intervention Measure of the intervention sessions. We will measure process parameters
(e.g., number of eligible participants, recruitment rate, retention rate). We will also
objectively measure mobile app features (e.g., app usage, time spent on each screen
view, user interaction with app user interface (i.e., button clicks and usage details)). We
will explore the effect of VA-GMI mobile app on a number of domains hypothesized to
be impacted by the intervention to aid in our responder analysis. Several measures will
also be captured to characterize the population and inform outcome measurement
selection for future studies. Outcome measures will be collected at baseline, post-
intervention, 3-months, and 6-months from the baseline evaluation.
This Career Development Award-2 work supports the development and training for Dr.
Tonya Rich to become an independent VA researcher focused on the development and
testing of novel r...

## Key facts

- **NIH application ID:** 10865385
- **Project number:** 1IK2RX004805-01A1
- **Recipient organization:** MINNEAPOLIS VA  MEDICAL CENTER
- **Principal Investigator:** Tonya L Rich
- **Activity code:** IK2 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2024
- **Award amount:** —
- **Award type:** 1
- **Project period:** 2024-04-01 → 2029-03-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10865385

## Citation

> US National Institutes of Health, RePORTER application 10865385, Home-based rehabilitation intervention for phantom limb pain in Veterans with lower limb amputations (1IK2RX004805-01A1). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/10865385. Licensed CC0.

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