Mirror therapy for treating the upper limbs after stroke: A systematic review

Abstract

Objective To evaluate the effectiveness of mirror therapy in treating the upper limbs of patients with stroke.Methods The PUBMED,MEDLINE,EMbase,Cochrane Central Register of Controlled Trials (CENTRAL),ISI Web of Knowledge,OVID,CNKI,VIP and Wanfang Data databases were searched for reports of randomized controlled trials (RCTs) of mirror therapy in the treatment of the upper limbs of patients with stroke from the date of establishment of each database to April 2012.The bibliographies of the studies retrieved were also searched.Two independent researchers evaluated the included studies using the risk of bias provided by Cochrane Library.The extracted data were analyzed using RevMan 5.1 software and version 3.6 of the GRAED profiler.Results Reports of 9 trials were discovered.Meta-analysis showed that compared to the group that didn't have visual feedback,mirror therapy did not significantly increase Fugl-Meyer assessment (FMA) (Upper Limb) scores after 4 weeks of treatment compared with groups that did not have visual feedback.Mirror therapy also did not significantly increase average scores on the action research arm test (ARAT) after 6 weeks of treatment.Mirror therapy did,however,increase average Brunnstrom stage scores for the hand after 4 weeks of treatment and at a 6-month follow-up.Mirror therapy did not increase average scores on the modified Ashworth scale (MAS) after 4 weeks of treatment,but increased MAS scores were observed at a 6-month follow-up compared with a group which had no visual feedback.Mirror therapy increased functional independence measure (FIM) self-care scores after 4 weeks of treatment and at a 6-month follow-up,and it also increased modified Barthel index (MBI) scores after 4 weeks of treatment.In the GRADE system,the scores of Brunnstrom stages for the hand after 4 weeks of treatment were of moderate quality,but those scores and the MAS scores at the 6-month follow-up were of low quality.The FIM selfcare scores after 4 weeks and at the 6-month follow-up and the MBI scores measured after 4 weeks were of very low quality.Conclusion This evidence shows that mirror therapy can improve upper limb function and quality of daily life to some extent after stroke.However,because of the limitations of the previous studies such as poor quality,different end points,different rating scales and different courses of stroke,more high-quality,randomized,controlled trials with larger samples are needed to evaluate the effectiveness of mirror therapy in the rehabilitation of upper limb function after stroke. Key words: Mirror therapy; Stroke; Hand function; Meta-analyses