Effect of Mirror Therapy on Recovery of Stroke Survivors: A Systematic Review and Network Meta-analysis

Mirror therapy (MT) as a relatively new rehabilitation technique has been widely applied in stroke patients. A number of randomized controlled trials (RCTs) have investigated the effects of MT for stroke survivors. The main purpose of this network meta-analysis was to investigate the effects of MT on motor function, activities of daily living (ADL), and pain perception in stroke survivors. Several databases were searched to identify RCTs evaluating the effects of MT in stroke patients to perform this network meta-analysis. Thirty-seven RCTs (42 analyses, 1685 subjects) were eligible for inclusion in the meta-analysis. Standard meta-analysis showed that MT significantly improved of motor function according to the increased Fugl-Meyer Assessment (FMA), Functional Independence Measure (FIM), and decreased Modified Ashworth Scale (MAS) score. In addition, ADL was promoted by MT as the elevated Modified Barthel Index (MBI) and Motor Activity Log (MAL) score. Moreover, MT effectively relieved the pain of stroke patients as the Visual Analog Scale (VAS) score was reduced. Subgroup analyses and meta-regressions identified that the sources of heterogeneity might be different intervention arms and duration of interventions. Network meta-analysis showed that MT combined with electrical stimulation (ES) for less than 4 weeks along with conventional rehabilitation therapy (CT), and MT accompanied with CT for less than 4 weeks might be the most suitable interventions for improvement of motor function and ADL, respectively. Overall, MT could effectively improve motor function and ADL, as well as relieve pain for stroke survivors. The study was registered at PROSPERO (CRD42017081742).