Effectiveness of self-administered mirror therapy on upper extremity impairments and function of acute stroke patients: study protocol

Venkadesan Rajendran, Deepa Jeevanantham, Céline Larivière, Ravinder-Jeet Singh, Lisa Zeman, Padma Papuri, Venkadesan Rajendran, Deepa Jeevanantham, Céline Larivière, Ravinder-Jeet Singh, Lisa Zeman, Padma Papuri

Abstract

Background: Many therapeutic interventions are performed by physiotherapists to improve upper extremity function and/or activities of daily living (ADL) in stroke patients. Mirror therapy (MT) is a simple technique that can be self-administered by the patients with intact cognition following patient education by a skilled physiotherapist. However, the effectiveness of self-administered MT in post-stroke patients in upper extremity function remains unclear. Therefore, the objective of this study is to examine the effectiveness of MT in improving upper extremity function and recovery in acute stroke patients.

Methods: This study is a single-center, prospective, randomized, open-label, controlled trial with blinded outcome evaluation (PROBE design), in which a total of 36 eligible acute stroke patients will be randomly assigned to control (n=18) and experimental group (n=18). Participants in the control group will receive regular rehabilitation interventions whereas participants in the experimental group will receive MT education in addition to their regular interventions for 4 weeks.

Study outcome: The primary outcome measure will be upper extremity function that will be measured using the Fugl-Meyer Assessment scale and the Wolf Motor Function Test. The secondary outcome measure will be behaviors related to ADL as estimated using the Modified Barthel Index. Outcome measures will be assessed at baseline and at 4 weeks post-rehabilitation intervention/MT.

Results: A two-way repeated analysis of variance (ANOVA) with time and group effects will be used to analyze between-group differences. The level of significance will be set at P < 0.05.

Conclusion: The results of the study will provide critical information to include self-administered MT as an adjuvant to regular interventions and may facilitate recovery of the upper extremity function of stroke patients.

Trial registration: ClinicalTrials.gov NCT04542772 . Registered on 9 September 2020. Protocol version: Final 1.0.

Keywords: Education; Mirror therapy; Stroke.

Conflict of interest statement

The authors declare that they have no competing interests.

© 2021. The Author(s).

Figures

Fig. 1
Fig. 1
Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) used to identify studies
Fig. 2
Fig. 2
Flow chart representing study process

References

    1. Sacco RL, Kasner SE, Broderick JP, Caplan LR, Connors JJ, Culebras A, Elkind MS, George MG, Hamdan AD, Higashida RT, Hoh BL, Janis LS, Kase CS, Kleindorfer DO, Lee JM, Moseley ME, Peterson ED, Turan TN, Valderrama AL, Vinters HV, American Heart Association Stroke Council, Council on Cardiovascular Surgery and Anesthesia., Council on Cardiovascular Radiology and Intervention., Council on Cardiovascular and Stroke Nursing., Council on Epidemiology and Prevention., Council on Peripheral Vascular Disease., Council on Nutrition, Physical Activity and Metabolism An updated definition of stroke for the 21st century: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2013;44(7):2064–2089. doi: 10.1161/STR.0b013e318296aeca.
    1. Stroke in Canada, (2016, October 27). In Public Health Agency of Canada. Retrieved September 30, 2019, from . Accessed 30 Dec 2020.
    1. Lawrence ES, Coshall C, Dundas R, Stewart J, Rudd AG, Howard R, Wolfe CD. Estimates of the prevalence of acute stroke impairments and disability in a multiethnic population. Stroke. 2001;32(6):1279–1284. doi: 10.1161/01.STR.32.6.1279.
    1. Hatem SM, Saussez G, Della Faille M, Prist V, Zhang X, Dispa D, Bleyenheuft Y. Rehabilitation of motor function after stroke: a multiple systematic review focused on techniques to stimulate upper extremity recovery. Front Hum Neurosci. 2016;10:442. doi: 10.3389/fnhum.2016.00442.
    1. Hebert D, Lindsay MP, McIntyre A, Kirton A, Rumney PG, Bagg S, Bayley M, Dowlatshahi D, Dukelow S, Garnhum M, Glasser E, Halabi ML, Kang E, MacKay-Lyons M, Martino R, Rochette A, Rowe S, Salbach N, Semenko B, Stack B, Swinton L, Weber V, Mayer M, Verrilli S, DeVeber G, Andersen J, Barlow K, Cassidy C, Dilenge ME, Fehlings D, Hung R, Iruthayarajah J, Lenz L, Majnemer A, Purtzki J, Rafay M, Sonnenberg LK, Townley A, Janzen S, Foley N, Teasell R. Canadian stroke best practice recommendations: stroke rehabilitation practice guidelines, update 2015. Int J Stroke. 2016;11(4):459–484. doi: 10.1177/1747493016643553.
    1. Seitz RJ, Höflich P, Binkofski F, Tellmann L, Herzog H, Freund HJ. Role of the premotor cortex in recovery from middle cerebral artery infarction. Arch Neurol. 1998;55(8):1081–1088. doi: 10.1001/archneur.55.8.1081.
    1. Bernhardt J, Hayward KS, Kwakkel G, Ward NS, Wolf SL, Borschmann K, Krakauer JW, Boyd LA, Carmichael ST, Corbett D, Cramer SC. Agreed definitions and a shared vision for new standards in stroke recovery research: The Stroke Recovery and Rehabilitation Roundtable taskforce. Int J Stroke. 2017;12(5):444–450. doi: 10.1177/1747493017711816.
    1. Dohle C, Püllen J, Nakaten A, Küst J, Rietz C, Karbe H. Mirror therapy promotes recovery from severe hemiparesis: a randomized controlled trial. Neurorehabil Neural Repair. 2009;23(3):209–217. doi: 10.1177/1545968308324786.
    1. Invernizzi M, Negrini S, Carda S, Lanzotti L, Cisari C, Baricich A. The value of adding mirror therapy for upper limb motor recovery of subacute stroke patients: a randomized controlled trial. Eur J Phys Rehabil Med. 2013;49(3):311–317.
    1. Yun GJ, Chun MH, Park JY, Kim BR. The synergic effects of mirror therapy and neuromuscular electrical stimulation for hand function in stroke patients. Ann Rehabil Med. 2011;35(3):316–321. doi: 10.5535/arm.2011.35.3.316.
    1. Yoon JA, Koo BI, Shin MJ, Shin YB, Ko HY, Shin YI. Effect of constraint-induced movement therapy and mirror therapy for patients with subacute stroke. Ann Rehabil Med. 2014;38(4):458–466. doi: 10.5535/arm.2014.38.4.458.
    1. Morkisch N, Thieme H, Dohle C. How to perform mirror therapy after stroke? Evidence from a meta-analysis. Restor Neurol Neurosci. 2019;37(5):421–435. doi: 10.3233/RNN-190935.
    1. Pérez-Cruzado D, Merchán-Baeza JA, González-Sánchez M, Cuesta-Vargas AI. Systematic review of mirror therapy compared with conventional rehabilitation in upper extremity function in stroke survivors. Aust Occup Ther J. 2017;64(2):91–112. doi: 10.1111/1440-1630.12342.
    1. Zeng W, Guo Y, Wu G, Liu X, Fang Q. Mirror therapy for motor function of the upper extremity in patients with stroke: a meta-analysis. J Rehabil Med. 2018;50(1):8–15. doi: 10.2340/16501977-2287.
    1. Thieme H, Mehrholz J, Pohl M, Behrens J, Dohle C. Mirror therapy for improving motor function after stroke. Cochrane Database Syst Rev. 2012;2012(3):CD008449. doi: 10.1002/14651858.CD008449.pub2.
    1. Mirela Cristina L, Matei D, Ignat B, Popescu CD. Mirror therapy enhances upper extremity motor recovery in stroke patients. Acta Neurol Belg. 2015;115(4):597–603. doi: 10.1007/s13760-015-0465-5.
    1. Yang Y, Zhao Q, Zhang Y, Wu Q, Jiang X, Cheng G. Effect of mirror therapy on recovery of stroke survivors: a systematic review and network meta-analysis. Neuroscience. 2018;390:318–336. doi: 10.1016/j.neuroscience.2018.06.044.
    1. Morkisch N, Jettkowski K, Ferreira dos Santos L, Dohle C. Modelling of therapeutic action during mirror therapy-Aqualitative analysis as basis for technical solutions. Curr Direct Biomed Eng. 2017;3(1):45–48. doi: 10.1515/cdbme-2017-0010.
    1. Thieme H, Morkisch N, Mehrholz J, et al. Mirror therapy for improving motor function after stroke. Cochrane Database Syst Rev. 2018;7(7):CD008449. doi: 10.1002/14651858.CD008449.pub3.
    1. di Pellegrino G, Fadiga L, Fogassi L, Gallese V, Rizzolatti G. Understanding motor events: a neurophysiological study. Exp Brain Res. 1992;91(1):176–180. doi: 10.1007/BF00230027.
    1. Wang J, Fritzsch C, Bernarding J, Krause T, Mauritz K-H, Brunetti M, Dohle C. Cerebral activation evoked by the mirror illusion of the hand in stroke patients compared to normal subjects. NeuroRehabilitation. 2013;4:593–603. doi: 10.3233/NRE-130999.
    1. Bodenheimer T, Lorig K, Holman H, Grumbach K. Patient self-management of chronic disease in primary care. JAMA. 2002;288(19):2469–2475. doi: 10.1001/jama.288.19.2469.
    1. Darnall BD, Li H. Home-based self-delivered mirror therapy for phantom pain: a pilot study. J Rehabil Med. 2012;44(3):254–60. 10.2340/16501977-0933. Accessed 30 Dec 2020.
    1. Samuelkamaleshkumar S, Reethajanetsureka S, Pauljebaraj P, Benshamir B, Padankatti SM, David JA. Mirror therapy enhances motor performance in the paretic upper limb after stroke: a pilot randomized controlled trial. Arch Phys Med Rehabil. 2014;95(11):2000–5. 10.1016/j.apmr.2014.06.020.
    1. Cantero-Téllez R, Naughton N, Algar L, Valdes K. Outcome measurement of hand function following mirror therapy for stroke rehabilitation: a systematic review. J Hand Ther. 2019;32(2):277–291. doi: 10.1016/j.jht.2018.01.009.
    1. Rose, D., Pinto-Zipp, G., Anderson, H., Bland, M., Byl, N., Capo-Lugo, C., Sulwer M., Yoshida, R. (2018). StrokeEDGE II outcome measures in acute care. Academy of Neurological Physical Therapy, division of American Physical Therapy Association, United States. Retrieved November 10, 2019, from .
    1. Shah PB. Intention-to-treat and per-protocol analysis. CMAJ. 2011;183(6):696. doi: 10.1503/cmaj.111-2033.
    1. Hawley-Hague H, Horne M, Skelton DA, Todd C. Review of how we should define (and measure) adherence in studies examining older adults' participation in exercise classes. BMJ Open. 2016;6(6):e011560. doi: 10.1136/bmjopen-2016-011560.

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