Interventional procedure overview of targeted muscle reinnervation for managing limb amputation pain

Appendix A: Methods and literature search strategy

Methods and literature search strategy

NICE has identified studies and reviews relevant to targeted muscle reinnervation for refractory pain after limb amputation from the medical literature.

Search strategy design and peer review

This search report is informed by the Preferred Reporting Items for Systematic reviews and Meta-Analyses literature search extension (PRISMA-S).

A NICE information specialist ran the literature searches on 02/08/2024. See the search strategy history for the full search strategy for each database. Relevant published studies identified during consultation or resolution that are published after this date may also be considered for inclusion.

The principal search strategy was developed in MEDLINE ALL (Ovid interface). It was adapted for use in each of the databases listed in table 4a, taking into account the database's size, search functionality and subject coverage. The MEDLINE ALL strategy was quality assured by a NICE senior information specialist. All translated search strategies were peer reviewed to ensure their accuracy. The quality assurance and peer review procedures were adapted from the Peer Review of Electronic Search Strategies (PRESS) 2015 evidence-based checklist.

Review management

The search results were managed in EPPI‑Reviewer version 5 (EPPI‑R5). Duplicates were removed in EPPI‑R5 using a 2‑step process. First, automated deduplication was done using a high-value algorithm. Second, manual deduplication was used to assess low-probability matches. All decisions about inclusion, exclusion and deduplication were recorded and stored.

Limits and restrictions

The search was not limited by date or language.

The CENTRAL database search removed trial registry records and conference material. The Embase search excluded conference material.

The limit to remove animal studies in the searches is standard NICE practice, which has been adapted from Dickersin K, Scherer R, Lefebvre C (1994) Systematic Reviews: Identifying relevant studies for systematic reviews. BMJ 309(6964): 1286.

Main search

Table 4a Main search results

MEDLINE ALL search strategy

1 , targeted muscle reinnervation.tw. , 294

2 , TMR.tw. , 2,815

3 , Nerve Transfer/ , 2,661

4 , (nerve* adj4 (transfer* or transplant* or re-rout* or rerout* or crossover* or dock* or regenerat*)).tw. , 18,294

5 , neurotizat*.tw. , 884

6 , Muscle, Skeletal/ir [Innervation] , 12,541

7 , (muscle* adj4 (skeletal* or voluntary or tibial or gastrocnemius or plantaris or soleus)).tw. , 158,412

8 , Peripheral Nerves/su , 2,315

9 , ((peripheral* adj4 nerve*) or endoneurium* or epineurium* or perineurium*).tw. , 54,304

10 , or/1-9 , 235,304

11 , exp Amputation, Surgical/ , 25,111

12 , exp Amputation Stumps/ , 3,261

13 , Amputation, Traumatic/ , 5,141

14 , Amputat*.tw. , 51,676

15 , (nerve* adj4 cut*).tw. , 7,351

16 , or/11-15 , 70,063

17 , Phantom Limb/ , 2,134

18 , (phantom adj (Limb* or pain* or sensation*)).tw. , 2,534

19 , (residual* adj Limb* adj4 (pain* or sensation*)).tw. , 252

20 , Pseudomelia*.tw. , 0

21 , exp Pain, Intractable/ , 6,430

22 , (Pain* adj4 (refract* or intractab* or severe* or constant* or debilitating*)).tw. , 48,538

23 , Neuritis/ , 5,100

24 , Neuralgia/ , 18,610

25 , (Neurit* or Neuralg* or polyneurit* or neurodynia*).tw. , 62,634

26 , Chronic Pain/ , 24,934

27 , (((chronic* or persist* or continual* or constant* or nerve*) and neuropath*) adj4 pain).tw. , 20,967

28 , or/17-27 , 164,444

29 , 10 and 16 and 28 , 448

30 , Animals/ not Humans/ , 5,210,707

31 , 29 not 30 , 386

Embase search strategy

1 , muscle reinnervation/ , 2,028

2 , TMR.tw. , 3,21

3 , nerve transplantation/ , 5,404

4 , (nerve* adj4 (transfer* or transplant* or re-rout* or rerout* or crossover* or dock* or regenerat*)).tw. , 21,27

5 , neurotizat*.tw. , 966

6 , innervation/ , 40,102

7 , (muscle* adj4 skeletal*).tw. , 170,288

8 , peripheral nerve/su [Surgery] , 463

9 , (peripheral* adj4 nerve*).tw. , 68,075

10 , innervat*.tw. , 72,854

11 , or/1-10 , 345,840

12 , exp amputation/ , 60,084

13 , amputat*.tw. , 65,926

14 , exp amputation stump/ , 2,30

15 , (nerve adj4 cut*).tw. , 6,954

16 , or/12-15 , 90,781

17 , phantom limb/ , 476

18 , ((Phantom* or residual*) adj Limb* adj4 (pain* or sensation*)).tw. , 2,207

19 , ((Phantom* or residual*) adj Limb* adj4 (pain* or sensation* or syndrom*)).tw. , 2,27

20 , exp intractable pain/ , 5,752

21 , (Pain adj4 (refract* or intractab* or severe* or constant* or debilitating*)).tw. , 74,768

22 , neuritis/ , 5,761

23 , neuralgia/ , 9,897

24 , (Neurit* or Neuralg* or polyneurit* or neurodynia*).tw. , 78,921

25 , chronic pain/ , 83,303

26 , ((chronic* or persist* or continual* or constant*) adj4 pain).tw. , 156,389

27 , or/17-26 , 318,208

28 , 11 and 16 and 27 , 719

29 , Nonhuman/ not Human/ , 5,503,992

30 , 28 not 29 , 659

31 , (conference abstract* or conference review or conference paper or conference proceeding).db,pt,su. , 5,993,676

32 , 30 not 31 , 438

Cochrane Library (CDSR and CENTRAL) search strategy

#1 targeted muscle reinnervation 19

#2 TMR 221

#3 MeSH descriptor: [Nerve Transfer] this term only 37

#4 (nerve* near/4 (transfer* or transplant* or re-rout* or rerout* or crossover* or dock* or regenerat*)) 710

#5 neurotizat* 22

#6 MeSH descriptor: [Muscle, Skeletal] this term only and with qualifier(s): [innervation - IR] 599

#7 (muscle* near/4 (skeletal* or voluntary or tibial or gastrocnemius or plantaris or soleus)) 18972

#8 MeSH descriptor: [Peripheral Nerves] explode all trees and with qualifier(s): [surgery - SU] 410

#9 ((peripheral* near/4 nerve*) or endoneurium* or epineurium* or perineurium*) 4729

#10 #1 or #2 or #3 or #4 or #5 or #6 or #7 or #8 or #9 24596

#11 MeSH descriptor: [Amputation, Surgical] explode all trees 685

#12 MeSH descriptor: [Amputation Stumps] explode all trees 71

#13 MeSH descriptor: [Amputation, Traumatic] this term only 71

#14 Amputat* 4479

#15 (nerve* near/4 cut*) 682

#16 #11 or #12 or #13 or #14 or #15 5145

#17 MeSH descriptor: [Phantom Limb] this term only 194

#18 (phantom near (Limb* or pain* or sensation*)) 526

#19 (residual* near Limb* near/4 (pain* or sensation*)) 55

#20 Pseudomelia* 0

#21 MeSH descriptor: [Pain, Intractable] this term only 349

#22 (Pain* near/4 (refract* or intractab* or severe* or constant* or debilitating*)) 13341

#23 MeSH descriptor: [Neuritis] this term only 107

#24 MeSH descriptor: [Neuralgia] this term only 1734

#25 (Neurit* or Neuralg* or polyneurit* or neurodynia*) 5259

#26 MeSH descriptor: [Chronic Pain] this term only 4667

#27 (((chronic* or persist* or continual* or constant* or nerve*) and neuropath*) near/4 pain) 3880

#28 #17 or #18 or #19 or #20 or #21 or #22 or #23 or #24 or #25 or #26 or #27 51283

#29 #10 AND #16 AND #28 165

Note: (CDSR 44, CENTRAL 120, Clinical Answers 1 [not exported])

INAHTA search strategy

1 , targeted muscle reinnervation , 1

2 , TMR , 6

3 , "Nerve Transfer"[mh] , 6

4 , (nerve* AND (transfer* or transplant* or re-rout* or rerout* or crossover* or dock* or regenerat*)) , 16

5 , neurotizat* , 0

6 , "Muscle, Skeletal"[mh] , 3

7 , (muscle* AND (skeletal* or voluntary or tibial or gastrocnemius or plantaris or soleus)) , 13

8 , "Peripheral Nerves"[mhe] , 94

9 , ((peripheral* AND nerve*) or endoneurium* or epineurium* or perineurium*) , 37

10 , #9 OR #8 OR #7 OR #6 OR #5 OR #4 OR #3 OR #2 OR #1 , 156

11 , "Amputation, Surgical"[mhe] , 10

12 , "Amputation Stumps"[mhe] , 3

14 , Amputat* , 84

15 , (nerve* AND cut*) , 9

16 , #15 OR #14 OR #13 OR #12 OR #11 , 94

17 , "Phantom Limb"[mh] , 2

18 , phantom AND (Limb* or pain* or sensation*)) , 5

19 , (residual* AND Limb* AND (pain* or sensation*)) , 1

20 , Pseudomelia* , 0

24 , "Neuralgia"[mh] , 49

25 , (Neurit* or Neuralg* or polyneurit* or neurodynia*) , 44

26 , "Chronic Pain"[mh] , 77

27 , (((chronic* or persist* or continual* or constant* or nerve*) and neuropath*) AND pain) , 36

28 , #27 OR #26 OR #25 OR #24 OR #23 OR #22 OR #21 OR #20 OR #19 OR #18 OR #17 , 381

29 , #28 AND #16 AND #10 , 165

Inclusion criteria

The following inclusion criteria were applied to the abstracts identified by the literature search.

Publication type: clinical studies were included with emphasis on identifying good quality studies. Abstracts were excluded if they did not report clinical outcomes. Reviews, editorials, and laboratory or animal studies, were also excluded and so were conference abstracts, because of the difficulty of appraising study methodology, unless they reported specific adverse events not available in the published literature.

People with upper or lower limb amputation.

Intervention or test: TMR.

Outcome: articles were retrieved if the abstract contained information relevant to the safety, efficacy, or both.

If selection criteria could not be determined from the abstracts the full paper was retrieved.

Potentially relevant studies not included in the main evidence summary are listed in Appendix B: Other relevant studies

Find out more about how NICE selects the evidence for the committee.