The value of adding mirror therapy for upper limb motor recovery of subacute stroke patients: a randomized controlled trial

Background. Upper limb paresis remains a relevant challenge in stroke rehabilitation. Aim. To evaluate if adding mirror therapy (MT) to conventional therapy (CT) can improve motor recovery of the upper limb in subacute stroke patients. Design. Prospective, single-center, single-blind, randomised, controlled trial. Setting. Subacute stroke patients referred to a Physical and Rehabilitation Medicine Unit between October 2009 and August 2011. Population. Twenty-six subacute stroke patients (time from stroke <4 weeks) with upper limb paresis (Motricity Index <= 77). Methods. Patients were randomly allocated to the MT (N.=13) or to the CT group (N.=13). Both followed a comprehensive rehabilitative treatment. In addition, MT Group had 30 minutes of MT while the CT group had 30 minutes of sham therapy. Action Research Arm Test (ARAT) was the primary outcome measures. Motricity Index (MI) and the Functional Independence Measure (FIM) were the secondary outcome measures. Results. After one month of treatment patients of both groups showed statistically significant improvements in all the variables measured (P<0.05). Moreover patients of the MT group had greater improvements in the ARAT, MI and FIM values compared to CT group (P<0.01, Glass's Delta Effect Size: 1.18). No relevant adverse event was recorded during the study. Conclusion. MT is a promising and easy method to improve motor recovery of the upper limb in subacute stroke patients. Clinical Rehabilitation impact. While MT use has been advocated for acute patients with no or negligible motor function, it can be usefully extended to patients who show partial motor recovery. The easiness of implementation, the low cost and the acceptability makes this therapy an useful tool in stroke rehabilitation.