Date Presented 04/01/2022
This study investigated the long-term effects of movement-based and task-based mirror therapy in people with poststroke hemiparesis. This follow-up study added a third time point to a previous randomized controlled trial and found significant long-term improvements in occupational performance, indicating maintained benefits of mirror therapy and some significant benefits in the task-based group, or benefits of purposeful action. However, study limitations inhibit drawing meaningful applications to the field of OT.
Primary Author and Speaker: Sara Corning
Additional Authors and Speakers: Mary Hildebrand
PURPOSE: The purpose of this research is to investigate the long-term effects on upper extremity function using movement-based mirror therapy (MBMT) and task-based mirror therapy (TBMT) in persons with post-stroke hemiparesis. This is an important population, given that stroke is the leading cause of disability in the US and hemiparesis is a common condition for stroke survivors that affects their upper extremity function. In occupational therapy, mirror therapy (MT) is widely supported in the literature as an effective intervention for persons with post-stroke hemiparesis. However, there are mixed results regarding whether TBMT or MBMT protocols are more effective and a gap in the literature regarding the long-term effects of MT. This indicates a need for further research to better inform OT practitioners about the effectiveness of this intervention.
DESIGN/METHOD: This is a follow-up study to a previously conducted randomized control trial involving 17 participants who were at least 6 months post-stroke. This study recruited from the previous participants and added a third time point to the previous pre/post data collection points. There were 10 participants who consented to take part in a one-time assessment that was conducted virtually via Zoom. The quantitative assessments included were the Disabilities of the Arm, Shoulder, and Hand Questionnaire (DASH) to assess upper extremity function, the 36-Item Short-Form Survey (SF-36) to assess overall health, and the Canadian Occupational Performance Measure (COPM) to assess self-report of occupational performance and satisfaction. Additionally, guiding questions were asked to explore participants’ perspectives during the MT interventions. Data was analyzed using SPSS to determine if there were significant differences between or within group.
RESULTS: There were significant improvements on the COPM performance scores and satisfaction scores from pre-test to post-test and from pre-test to follow-up; there was no significance between the post-test and follow up. This indicates that the benefits from MT did not continue to improve but that they were maintained long-term. There were significant differences in the TBMT and MBMT scores for the SF-36 sub-sections for general mental health, general health perceptions, and role limitations due to emotional health, with TBMT having more positive outcomes, indicating that engagement in purposeful activities appeared to have a more positive impact on participants’ perceptions of mental and emotional health compared to engagement in rote movements or exercises. The primary theme that emerged from the qualitative data, when participants were asked about use of their affected arm/hand, was that MT Increased Use of the Hand. These comments provide support to the theory that MT counteracts learned nonuse. Limitations of this study are substantial and include a very small sample size, widely varying times for participants post-stroke, and confounding factors such as participation in other therapies and other health problems.
CONCLUSION: There may be long term benefits of MT interventions, but our results are inconclusive due to many confounding factors. In addition, there is still no conclusive evidence that TMBT is significantly more effective than MBMT.
IMPACT STATEMENT: This study is important to indicate the potential support of task-based interventions, as well as the potential long-term benefits of MT. However, due to limitations in the study, there is a need for further research into the effectiveness of different types of MT interventions and the long-term effects of these protocols.
Arya, K. N., Pandian, S., Kumar, D., & Puri, V. (2015). Task-based mirror therapy augmenting motor recovery in poststroke hemiparesis: A randomized controlled trial. Journal of Stroke and Cerebrovascular Diseases, 24(8), 1738-1748. https://doi.org/10.1016/j.jstrokecerebrovasdis.2015.03.026
Heidt, A. (2019). Effects of task-based mirror therapy on proximal joints in stroke patients with hemiparesis [Unpublished doctoral thesis]. MGH Institute of Health Professions.
Thieme, H., Morkisch, N., Mehrholz, J., Pohl, M., Behrens, J., Borgetto, B., & Dohle, C. (2018). Mirror therapy for improving motor function after stroke. Cochrane Database of Systematic Reviews, 7. https://doi.org/10.1002/14651858.CD008449.pub3