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

Zhonghua Luo; Yuqing Zhou; He He; Shanshan Lin; Rui Zhu; Zhen Liu; Jiemei Liu; Xiaoli Liu; Shuping Chen; Jihua Zou; Qing Zeng

doi:10.3389/fneur.2020.00155

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

Front Neurol. 2020 Apr 2:11:155. doi: 10.3389/fneur.2020.00155. eCollection 2020.

Authors

Zhonghua Luo¹, Yuqing Zhou², He He², Shanshan Lin³, Rui Zhu², Zhen Liu⁴, Jiemei Liu⁵, Xiaoli Liu², Shuping Chen^{2

6}, Jihua Zou^{2

6}, Qing Zeng^{2

6}

Affiliations

¹ First Clinical Medical College, Southern Medical University, Guangzhou, China.
² Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China.
³ Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
⁴ Department of Rehabilitation Medicine, The First People's Hospital of Foshan, Foshan, Guangdong, China.
⁵ Department of Rehabilitation Medicine, Shunde Hospital, Southern Medical University, Guangzhou, China.
⁶ School of Rehabilitation Medicine, Southern Medical University, Guangzhou, China.

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 (χ2 = 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 is better than single rehabilitation therapy. However, more randomized controlled clinical trials and larger sample sizes are required for an in-depth meta-analysis.

Keywords: combined therapy; functional recovery; mirror therapy; stroke; upper limb.

Publication types

Systematic Review