Abstract
Specific Aims: To carry out a systematic review and meta-analysis of randomized controlled trials (RCTs) in the treatment of unilateral neglect after stroke using mirror therapy (MT). Approach: Inclusion criteria: We used the following criteria: RCTs of MT in the treatment of hemi-neglect and stroke, use of standardized tools to document neglect, clearly defined intervention including duration of treatment and blinded outcome assessment. We conducted a literature search on stroke and hemi neglect limited to the following databases: Cochrane Library, PubMed/Medline, PeDRO, Cinahl and EIRA. There were 15034 hits between 1990 to 2013 with the key words cerebrovascular accident (MeSH) and rehabilitation; there were 1578 hits with hemispatial neglect and rehabilitation. There were 16 RCTs trials where MT was used to study motor recovery. Out of 16 trials, only in 3 RCTs MT was evaluated in hemineglect patients. Innovation: The 3 trials had used different screening tools and outcome measures. Star cancellation score was the common outcome measure used in 2 RCT’s and in the 3rd study they used self-defined neglect score. There were total 75 patients. Using change in the star cancellation score from the baseline, we found that MT had significant effect on improving visuospatial neglect at the end of intervention: Standard mean deviation (SMD) 2.61: 95% confidence interval (CI) 1.85 to 3.36; P<0.00001. A single trial had done follow up at 6 months and showed significant positive effect: SMD 3.67; 95% CI 2.70 to 4.65; P<0.00001. Third study used self-defined five point neglect score based on the Behavioral Inattention Test (BIT) and the Test of Attentional Performance (TAP) and showed significant improvement in the treatment group (SMD 1.22; 95% CI 0.24 to 2.19; P=0.01) Conclusion: MT had significant effect on visuospatial neglect at the end of intervention and at 6 months follow up. However there is no large scale RCT available in the use of MT in the treatment of unilateral neglect.
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