Effects of mirror therapy on oedema, pain and functional activities in patients with poststroke shoulder-hand syndrome: A randomized controlled trial

Abstract

Objectives: To study the effectiveness of mirror therapy along with a Stroke rehabilitation program on oedema, pain intensity and functional activities in patients with shoulder-hand syndrome (SHS) after stroke.

Design: Randomized controlled trial.

Settings: Out-patient rehabilitation center.

Methods: Thirty-eight SHS patients after stroke, were randomly allocated into two groups; both the groups received a 4-week stroke rehabilitation program, 30 min a day for 5 days a week. Control group patients performed all the exercises of stroke rehabilitation program, while directly visualizing their both limbs. Experimental group patients performed same exercises of stroke rehabilitation program in front of the mirror.

Outcome measures: Oedema (figure-of-eight measurement method), pain intensity (0-10 Numeric Pain Rating Scale [0-10 NPRS]), functional activities (Functional Independence Measure [FIM]).

Results: After intervention, both groups showed statistically significant (p < 0.05) improvement for all measures (oedema measurement, 0-10 NPRS and FIM). Improvements were more significant (p < 0.05) in the experimental group with mirror therapy for all three measures compared to the control group. Mean differences between groups were 1.40 cm for oedema measurement, 0.87 for NPRS score and 12.20 for FIM score. At 2-week follow-up, the improvements were sustained.

Conclusion: The current study may indicate mirror therapy as an effective central neuromodulatory rehabilitative program to reduce pain, improves functional activities. More distinctively, this preliminary study suggests a decrease in oedema by mirror therapy for SHS after stroke. Improvement of upper limb in SHS after stroke will be more perceptible with the decrease in oedema, being the characteristic sign, following mirror therapy. Clinically, patients during their daily functional activities, shall be more confident to use their upper limb following mirror therapy after reduction in oedema along with pain.

Keywords: functional activities; mirror therapy; oedema; shoulder-hand syndrome; stroke.