Effects of mirror therapy on upper limb motor function of patients with stroke: A systematic review and meta-analysis of randomized controlled trials

Objectives This study aimed to investigate and review the effects of mirror therapy on upper limb function, including improvements in shoulder, elbow, forearm, wrist, and hand function, as well as coordination between the upper extremities, in patients with stroke. Data sources Six databases, CINAHL Plus with Full Text, Cochrane Central Register of Controlled Trials, Embase, Medline Complete, PubMed, and Web of Science, were searched from database inception to 15 October 2024, as well as manual searching of Google Scholar, for relevant trials. Review methods The methodological quality of the trials was assessed using version 2 of the Cochrane risk-of-bias tool with five domains. A random-effects model was applied to calculate the pooled mean difference of dichotomous variables using the 95% confidence interval. The variance in effect estimation in a forest plot for each trial was then quantified using I 2 . Results Eighteen studies, representing 633 patients with stroke, were included in this study. Mirror therapy significantly improved upper limb motor function (mean difference [MD] = 1.79; 95% CI = 0.04–3.54; p = 0.04) and hand function (MD = 1.48; 95% CI = 0.17–2.78; p = 0.03) in patients with stroke. Subgroup analyses of overall upper limb function showed that mirror therapy was effective in improving function when delivered more than 5 times a week (MD = 2.75; 95% CI = 1.02–4.48) over a period of ≤ 4 weeks (MD = 3.26; 95% CI = 1.19–5.33). The results of the methodology assessment using RoB-2 on all the trials included in the analysis showed that 16 trials were considered to have some concerns. Conclusion Mirror therapy appears to be beneficial for improving upper limb motor function after stroke. More trials are needed to determine the effects of mirror therapy on shoulder/elbow/forearm, wrist, and hand function and coordination between upper extremities after stroke.