Decreasing phantom limb pain through observation of action and imagery: a case series.

BACKGROUND: Phantom limb pain is often resistant to treatment. Techniques based on visual-kinesthetic feedback could help reduce it. OBJECTIVE: The objective of the current study was to test if a novel intervention combining observation and imagination of movements can reduce phantom limb pain. METHODS: This single-case multiple baseline study included six persons with upper or lower limb phantom pain. Participants' pain and imagery abilities were assessed by questionnaires. After a 3-5-week baseline, participants received a two-step intervention of 8 weeks. Intervention 1 was conducted at the laboratory with a therapist (two sessions/week) and at home (three sessions/week); and Intervention 2 was conducted at home only (five times/week). Interventions combined observation and imagination of missing limb movements. Participants rated their pain level and their ease to imagine daily throughout the study. RESULTS: Time series analyses showed that three participants rated their pain gradually and significantly lower during Intervention 1. During Intervention 2, additional changes in pain slopes were not significant. Four participants reported a reduction of pain greater than 30% from baseline to the end of Intervention 2, and only one maintained his gains after 6 months. Group analyses confirmed that average pain levels were lower after intervention than at baseline and had returned to baseline after 6 months. Social support, degree of functionality, and perception of control about their lives prior to the intervention correlated significantly with pain reduction. CONCLUSIONS: Persons with phantom limb pain may benefit from this novel intervention combining observation and motor imagery. Additional studies are needed to confirm our findings, elucidate mechanisms, and identify patients likely to respond.

Effect of intrapartum antibiotic prophylaxis against group B streptococcal infection on comparisons of rates of endometritis and urinary tract infection in multicenter surveillance.

OBJECTIVE: To establish whether antibiotic prophylaxis against group B streptococcal infection may be a confounding factor in comparisons of rates of endometritis and urinary tract infection after vaginal delivery. DESIGN: Prospective study. SETTING: Maternity units at 48 hospitals in a regional surveillance network in France during 2001-2004. METHODS: The maternity units used a common protocol to establish whether antibiotic prophylaxis was indicated. Risk factors for endometritis and urinary tract infections were evaluated using multiple logistic regression. RESULTS: We analyzed 49,786 vaginal deliveries. The percentage of women receiving antibiotic prophylaxis varied widely and significantly among the maternity units (range, 4.4%-26.0%; median, 15.8%; 25th percentile, 12.1%; 75th percentile, 19.0%) (P < .001, by Mantel-Haenszel chi(2) test). The incidence rate of endometritis was significantly reduced from 0.25% to 0.11% by antibiotic prophylaxis (P = .001). There was a decrease in the incidence of urinary tract infection from 0.37% to 0.32%, but it was not statistically significant (P = .251). CONCLUSIONS: A reduction in the incidence of endometritis was observed when intrapartum antibiotic prophylaxis against group B streptococcal infection was used. However, the proportion of women considered to be at risk of infection varied widely among institutions. Comparisons of rates of endometritis among maternity units, but not urinary tract infection rates, should take into account antibiotic prophylaxis as a significant confounding factor.