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The clinical aspects of mirror therapy in rehabilitation: a systematic review of the literature

Rothgangel, Andreas Stefana,f; Braun, Susy M.a,b,c,d; Beurskens, Anna J.a,b,c; Seitz, Rüdiger J.g; Wade, Derick T.e,h

International Journal of Rehabilitation Research: March 2011 - Volume 34 - Issue 1 - p 1–13
doi: 10.1097/MRR.0b013e3283441e98
Review article

The objective of this study was to evaluate the clinical aspects of mirror therapy (MT) interventions after stroke, phantom limb pain and complex regional pain syndrome. A systematic literature search of the Cochrane Database of controlled trials, PubMed/MEDLINE, CINAHL, EMBASE, PsycINFO, PEDro, RehabTrials and Rehadat, was made by two investigators independently (A.S.R. and M.J.). No restrictions were made regarding study design and type or localization of stroke, complex regional pain syndrome and amputation. Only studies that had MT given as a long-term treatment were included. Two authors (A.S.R. and S.M.B.) independently assessed studies for eligibility and risk of bias by using the Amsterdam–Maastricht Consensus List. Ten randomized trials, seven patient series and four single-case studies were included. The studies were heterogeneous regarding design, size, conditions studied and outcome measures. Methodological quality varied; only a few studies were of high quality. Important clinical aspects, such as assessment of possible side effects, were only insufficiently addressed. For stroke there is a moderate quality of evidence that MT as an additional intervention improves recovery of arm function, and a low quality of evidence regarding lower limb function and pain after stroke. The quality of evidence in patients with complex regional pain syndrome and phantom limb pain is also low. Firm conclusions could not be drawn. Little is known about which patients are likely to benefit most from MT, and how MT should preferably be applied. Future studies with clear descriptions of intervention protocols should focus on standardized outcome measures and systematically register adverse effects.

a The Department of Health and Technique, Zuyd University of Applied Sciences

b The Centre of Expertise in Life Sciences

c The Research Centre Autonomy and Participation for People with Chronic Illnesses, Zuyd University, Heerlen

d The Care and Public Health Institute

e Department of Rehabilitation, Maastricht University, Maastricht, The Netherlands

f Department of Pain Management, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil GmbH Bochum, Ruhr-University, Bochum

g Department of Neurology, Duesseldorf University Hospital, Duesseldorf, Germany

h Oxford Centre for Enablement, Oxford, UK

Correspondence to Andreas Stefan Rothgangel, M.Sc, Department of Health and Technique, Zuyd University, Nieuw Eyckholt 300, 6419 DJ Heerlen, The Netherlands Tel: +31 45 4006371; fax: +31 45 4006369; e-mail:

Received November 5, 2010

Accepted December 27, 2010

© 2011 Lippincott Williams & Wilkins, Inc.