Mirror therapy in unilateral neglect after stroke (MUST trial): a randomized controlled trial

Abstract

Objective: We explored the effectiveness of mirror therapy (MT) in the treatment of unilateral neglect in stroke patients.

Methods: This is an open, blinded endpoint, randomized controlled trial carried out from January 2011 to August 2013. We included stroke patients with thalamic and parietal lobe lesions with unilateral neglect 48 hours after stroke. Patients were randomized to the MT group or the control group (sham MT), and both the groups received limb activation. Patients received treatment for 1-2 hours a day 5 days a week for 4 weeks. The primary outcome was unilateral neglect assessed by a blinded assessor using the star cancellation test, the line bisection test, and a picture identification task at 1, 3, and 6 months. This study was registered at http://clinicaltrials.gov (NCT 01735877).

Results: Forty-eight patients were randomized to MT (n = 27) or the control group (n = 21). Improvement in scores on the star cancellation test over 6 months was greater in the MT group (mean difference 23, 95% confidence interval [CI] 19-28; p < 0.0001). Similarly, improvement in the MT group was observed in the scores on the picture identification task (mean difference 3.2, 95% CI 2.4-4.0; p < 0.0001) and line bisection test (mean difference 8.6, 95% CI 2.7-14.6; p = 0.006).

Conclusions: In patients with stroke, MT is a simple treatment that improves unilateral neglect.

Classification of evidence: This study provides Class I evidence that for patients with neglect from thalamic and parietal lobe strokes, MT improves neglect.

Trial registration: ClinicalTrials.gov NCT01735877.

Figure 1. Mirror therapy and sham mirror therapy

(A) Patient performing mirror therapy of affected left upper extremity. (B) Patient performing sham mirror therapy using nonreflecting side of mirror.

Figure 2. Recruitment of stroke patients in the study

Figure 3. Mean changes in star cancellation test

Comparison of mean changes in the treatment group and the control group on the star cancellation test. The mean change with 95% confidence interval is given, and the p value shows the difference between the treatment and control groups.

Figure 4. Mean changes in line bisection test and picture identification task

(A) Comparison of mean changes in the treatment group and the control group on the line bisection test. The mean change with 95% confidence interval (CI) is given, and the p value shows the difference between the treatment and control groups. (B) Comparison of mean changes in the treatment group and the control group on the picture identification task. The mean change with 95% CI is given, and the p value shows the difference between the treatment and control groups.