Mirror Therapy in Stroke Rehabilitation: Why, How Early, and Effects: A Meta-analysis

Abstract

Background and Aims: The use of visual stimuli to facilitate a desired response in the affected limb in mirror therapy (MT) makes it an effective treatment modality even in instances of a complete plegic upper extremity poststroke. This article analyzes the effects of MT on impairments, activity limitation, and participation restriction in the acute and chronic phases poststroke. Methods: In total, 16 out of 3871 studies were included in the meta-analysis, using PRISMA guidelines. Data were categorized based on application in stroke rehabilitation (acute/chronic, motor/sensory/neglect/activity of daily living, upper limb/lower limb), modes and dosage of intervention delivery, types of control, and outcome assessment. RevMan 5.0 software was used for analysis. Results: Studies were equally distributed between chronic and acute phases. Therapy durations lasted between 1 and 8 weeks. Most studies intervened for upper limb motor impairments showing improvement in Brunnstrom motor recovery stages of arm ( P value: .04, 95% CI, 0.05-1.54, I2 = 59%) and hand ( P value: <.001, 95% CI, 0.80-2.01, I2 = 0%) during acute phase (0-4 weeks). “Activity/function” measured by functional independence measure showed improvement only in self-care subsection ( P value: <.001, 95% CI, 2.05-5.16, I2 = 0%). No long-term effects were analyzed in any of the included studies. Conclusion: A significant finding of this study is the role of MT in improving arm and hand impairments in acute phase poststroke. Rehabilitation protocols can be improved based on this finding. As MT is effective, affordable, and feasible, we have made suggestions toward its incorporation in physiotherapy protocols for low- and middle-income countries.

Re-evaluation of Mirror Visual Feedback Therapy for a Systematic Evaluation/Meta-analysis of Physical Function Re-education After Stroke

“…The articles included in this study were published in Chinese and English. Among them, 16 articles were journal articles 9–12,14–25 . All original studies were RCTs 13 .…”

“…The interventions provided to the experimental group were mirror visual feedback therapy alone or combined with conventional rehabilitation therapy, while the interventions provided to the control group were conventional rehabilitation therapy or sham mirror therapy. Eleven articles 11–14,16,18–20,22,24,25 assessed the methodological quality of RCTs by applying the Cochrane Handbook Systematic Evaluation Tool, four by applying the PEDro scale, 9,10,21,23 one study 17 applied the modified Jadad scale, while one study 15 applied the Physiotherapy Evidence Database scale. The basic characteristics of the included studies are shown in Table 1 (the complete Table 1 is in Supplemental Digital Content 2, http://links.lww.com/PHM/B748).…”

“…(2) Brunnstrom grading evaluation Eight articles 9,10,[14][15][16]18,20,24 were combined and analyzed for the outcomes of Brunnstrom's grading evaluation, three of which reported Brunnstrom's grading scores, 15,18,24 two articles 14,20 reported Brunnstrom classification (hand), three studies documented 9,16,20 the Brunnstrom classification (upper limb), and one article 10 reported the Brunnstrom classification (lower limb). One study 14 showed no statistically significant difference between the experimental group and the control group (weighted mean difference [WMD] = 0.55, 95% confidence interval [CI] = −0.51 to 1.61, P = 0.31), and the remaining seven studies 9,10,15,16,18,20,24 all showed better results in the experimental group than in the control group.…”

“…(3) BBT Evaluation Three articles 9,15,20 combined analyses of BBT scores, and all showed significant efficacy of the trial intervention in improving motor function of the affected upper limb in patients with stroke.…”

“…Among the included articles, 10 articles were published in Chinese [9][10][11][12][13][14][15][16][17][18] and seven articles were published in English. [19][20][21][22][23][24][25] The articles included in this study were published in Chinese and English. Among them, 16 articles were journal articles.…”