Unilateral mirror therapy may improve upper limb motor recovery after stroke but bilateral mirror therapy provides little or no additional benefit: a systematic review.

Abstract

Is mirror therapy, using only the intact upper limb (unilateral), superior to the same amount and type of practice without the mirror at reducing upper limb impairments or activity limitations? Is mirror therapy, using the intact and the affected upper limb (bilateral), superior to the same amount and type of practice without the mirror at reducing upper limb impairments or activity limitations? Systematic review of randomised trials with meta-analysis. Adults at any time after stroke of any severity. Supervised mirror therapy for the upper limb. Motor impairments and/or activities. A total of 19 trials, involving 618 participants, were included. The mean PEDro score of the trials was 6 (range 3 to 8). Low-level evidence indicates that unilateral mirror therapy may have a moderate effect on motor recovery (SMD 0.48, 95% CI 0.14 to 0.82) and moderate level evidence indicates that this is similar in terms of the Fugl-Meyer Assessment (MD 5 out of 66 points, 95% CI 0 to 10). Moderate-level evidence indicates that bilateral mirror therapy has little or no effect on motor recovery (SMD 0.15, 95% CI -0.07 to 0.38) and moderate level evidence indicates that this is similar in terms of the Fugl-Meyer Assessment (MD 2 out of 66 points, 95% CI -1 to 6). This systematic review suggests that unilateral mirror therapy may improve motor recovery after stroke. In contrast, bilateral mirror therapy appears to offer little benefit compared with practice without the mirror. PROSPERO (CRD420251038374).