Synergistic Effect of Combined Mirror Therapy on Upper Extremity in Patients With Stroke: A Systematic Review and Meta-Analysis

Abstract

Background: There is an increasing trend for researchers to combine mirror therapy with another rehabilitation therapy when treating the upper extremity of patients with stroke.Objective: To evaluate the synergistic effect of combined mirror therapy (MT) on the upper extremity in patients with stroke and to judge efficacies of four combined mirror therapy subgroups [EMGBF group: electromyographic biofeedback (EMGBF) + MT; MG group: mesh glove (MG) + MT; AT group: acupuncture (AT) + MT; ES group: EMG-triggered electrical stimulation (ES) + MT].Methods: CNKI, Wan Fang, VIP, Web of Science, ScienceDirect, PubMed, OVID LWW, and Cochrane were used. We searched these databases for randomized controlled trials published from January 2013 to August 2019, which presented results of combining mirror therapy with other rehabilitation therapies. Quality assessments were performed using the Cochrane Handbook criteria in order to accurately review interventions. The primary outcomes were measured by the Fugl-Meyer Assessment-upper extremity (FMA-UE).Results: Ten trials, with a total of 444 patients whose upper limb functions were damaged after stroke, were included in the meta-analysis. Compared with the control group, a remarkable effect of combined mirror therapy [all: weight mean difference in random effects model (WMD): 8.07, 95% confidence interval (CI) 5.87, 10.26] on functional recovery of the upper limb was detected. However, a high value of heterogeneity (χ 2 = 20.09, df = 9; I 2 = 55%) was found. The subgroup analysis (EMGBF group: WMD = 8.95, 95% CI 6.33, 11.58; ES group: WMD = 10.14, 95% CI: 5.67, 15.01) showed moderate improvement in functional recovery of the upper extremity in patients with stroke when mirror therapy was combined with conventional therapy. Furthermore, no difference in efficacy on upper extremity in patients with stroke was observed between the EMGBF group and the ES group. Conclusion:Despite the heterogeneity, the results indicate that combining mirror therapy with another rehabilitation therapy on the upper extremity in patients with stroke Luo et al.Combined Mirror Therapy is better than single rehabilitation therapy. However, more randomized controlled clinical trials and larger sample sizes are required for an in-depth meta-analysis.

Mirror therapy simultaneously combined with electrical stimulation for upper limb motor function recovery after stroke: a systematic review and meta-analysis of randomized controlled trials

“…Due to the lack of systematic review or meta-analysis analyzing the synergic effect of this intervention, the present findings will be compared to similar, though not specific, research. Contrary to our findings, Luo et al 28 concluded that mirror therapy combined with other treatment modalities was effective to improve upper extremity motor function in stroke patients compared with conventional therapy. However, the authors were not specifically focused on analyze the effects of the simultaneous combination of mirror therapy and electrical stimulation, and the heterogeneity of the studies included in the meta-analysis was high.…”

Synergistic Immediate Cortical Activation on Mirror Visual Feedback Combined With a Soft Robotic Bilateral Hand Rehabilitation System: A Functional Near Infrared Spectroscopy Study

“…However, due to the small sample size and large heterogeneity of patients (including the locations and side of brain injury, motor and cognitive impairment levels, sensory function, and even age, etc.) (Luo et al, 2020), the clinical efficacy and related mechanisms of MVF still needs further analysis. More recently, the Central-Peripheral-Central closed-loop regulation mode, formed by the combination of MVF as a central intervention method with other peripheral interventions, has become a research hotspot to further improve the technique.…”

Effects of Mirror Therapy Combined With EMG-triggered Functional Electrical Stimulation to Improve on Upper Extremity Function in Patient with Chronic Stroke

“…The results of this analysis suggest that the effects on both motor function and impairment of the affected upper limb depend on the therapy protocol [51]. Combining mirror therapy with another rehabilitation therapy on the upper extremity in patients with stroke is better than single rehabilitation therapy [52]. Among them, Additional mirror therapy in combination with EMG-This document was downloaded for personal use only.…”