Maximum tolerable daily dose of mirror movement therapy ankle exercises after stroke: an early phase dose screening study

Abstract

BackgroundMirror movement therapy may reduce lower limb motor impairment after stroke. The dose is unknown. Objectiveidentify the maximum tolerable dose a day (MTD) of lower limb mirror movement therapy Design3 + 3 cohort rule-based, dose escalation/de-escalation study. After undertaking baseline measures participants performed mirror movement therapy for 14 consecutive days. Participants then undertook outcome measures. Cohort One trained for 15 minutes daily. Subsequent cohorts exercised at a dose set according to pre-set rules and the modified Fibonacci sequence. The study stopped when the difference between set doses for consecutive cohorts was 10% or less. SettingParticipants’ homes (intervention) and a movement analysis laboratory (measures). ParticipantsAdults discharged from statutory stroke rehabilitation services. InterventionMirror movement therapy ankle exercises. Outcome measuresMotricity Index (primary) and bilateral time symmetry from movement onset to peak activation of Tibialis Anterior muscles during standardised sit-to-stand (secondary). ResultsFive cohorts of three participants were included (n = 15). Mean (SD) age and time after stroke were 61 (9) years and 35 (42) months respectively. Set daily doses for the five cohorts were: 15, 30, 50, 40 then 35 minutes. The set dose for a subsequent cohort (six) would have been 38 minutes thus the difference from cohort five would have been three minutes i.e., 9% different. Therefore, the study stopped ConclusionThe identified MTD of lower limb mirror therapy was 35 minutes daily when frequency was set at seven days a week and duration as two weeks. Clinical Trial Registration numberNCT04339803 (ClinicalTrials.gov) Contribution of the PaperThis early phase study found that the maximum tolerable dose per day (MTD) of mirror movement therapy ankle exercises was 35 minutes when frequency was set at seven days a week and duration as two weeks. The optimal therapeutic dose will therefore be somewhere in the range of 15 (starting dose) to 35 minutes per day. Further dose articulation studies are required to identify the optimal therapeutic dose before use of findings in clinical practice. This study is the first step in that research process.