EFFECTIVENESS OF VR THERAPY USING THE VRNOW SIMULATOR FOR PHANTOM LIMB PAIN FOLLOWING LOWER LIMB AMPUTATION
DOI:
https://doi.org/10.32782/2522-1795.2026.20.1.6Słowa kluczowe:
lower limb amputation; pain management; rehabilitation intervention; functional training; virtual reality; military personnelAbstrakt
Under conditions of martial law in Ukraine, a marked increase in the incidence of traumatic amputations has been observed, which highlights the urgent need for effective rehabilitation strategies. Military amputees, despite their high motivation to return to an active and meaningful life, frequently experience pronounced pain syndromes, including residual limb pain and phantom limb pain. The intensity and chronicity of pain may substantially limit physical activity, hinder prosthetic training, and adversely affect psycho-emotional well-being. In this context, effective pain management constitutes a key prerequisite for successful rehabilitation, as pain reduction provides the foundation for functional recovery and reintegration into an active lifestyle. Mirror therapy demonstrates limited clinical effectiveness and is associated with a number of anatomical and motivational barriers. Virtual reality is therefore considered an alternative approach to sensorimotor reintegration, offering enhanced feedback and improved patient compliance. Accordingly, investigation of the effectiveness of VR therapy represents a timely and well-justified direction in contemporary rehabilitation science.
The objective of the study is to demonstrate the effectiveness of VR therapy using the VRNOW simulator in the management of phantom limb pain in patients following lower limb amputation.
Materials and Methods. The study was conducted at the Medical Centre “Path to Health” LLC during 2024–2025 and consisted of two 14-day treatment courses. A total of 36 patients after lower limb amputation participated in the study during the third (pre-prosthetic rehabilitation) and fourth (prosthetic rehabilitation) stages of the rehabilitation process. The mean age of the male participants was 41,2±8 years; all patients were military personnel. Transtibial amputations accounted for 63,9% (n=23) of cases, while transfemoral amputations accounted for 36,1% (n=13). Phantom pain dynamics and quality of life were assessed using the Phantom and Stump Pain Questionnaire (PSPQ), the SF-36 Health Survey, and a pain diary. VR therapy using the VRNOW simulator was administered twice daily, with session durations of 20-30 minutes during Stage III and 35-45 minutes during Stage IV, based on an individualised selection of virtual tasks.
Results. VR therapy resulted in clinically significant improvements across multiple pain parameters. According to the PSPQ (NRS index), the number of patients with moderate residual limb pain decreased from 22 to 6, while 33,3% of patients (n=12) reported complete pain relief (mean score 1,83±0,28; p≤0,001). A substantial reduction was also observed in the number of patients with persistent phantom limb pain (from 30 to 8), with complete pain resolution reported in 44,4% of cases (n=16; mean score 1,44±0,28; p≤0,001). In addition, a marked decrease in persistent phantom sensations was noted, along with the disappearance of intrusive symptoms. Statistically significant improvements were recorded in most SF-36 domains, with the greatest increase observed in the bodily pain scale (BP +28,4 points; p≤0,001), confirming a pronounced analgesic effect. The increase in the Global Health Index (GHI +12,0 points; p≤0,01) reflects a clinically meaningful transition to a higher level of functioning.
Conclusions. The use of VR therapy with the VRNOW simulator in patients after lower limb amputation contributes to the reduction of residual limb pain, phantom limb pain, and phantom sensations through staged sensorimotor stimulation and restoration of neural connections. During Stage III (pre-prosthetic rehabilitation), the application of the Virtual Limb mode, isometric exercises, and virtual interaction with objects facilitates the formation of controlled visuomotor feedback, resulting in reduced pain intensity, attenuation of phantom sensations, and normalisation of perception of the missing limb. During Stage IV (prosthetic rehabilitation), the therapeutic focus shifts towards the restoration of proprioception, gait symmetry, and dynamic balance, which collectively enhance functional capacity and improve quality of life in patients after lower limb amputation.
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