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Meta-Analysis
. 2025 May;17(5):567-581.
doi: 10.1002/pmrj.13316. Epub 2025 Jan 24.

Effects of mirror therapy on motor and functional recovery of the upper extremity in subacute stroke: Systematic review and meta-analysis

Yuan-Lun Hsieh  1   2 , Tzu-Ying Yang  1   3 , Zi-You Peng  1   4 , Ray-Yau Wang  1 , Hui-Ting Shih  1 , Yea-Ru Yang  1
Affiliations
Meta-Analysis

Effects of mirror therapy on motor and functional recovery of the upper extremity in subacute stroke: Systematic review and meta-analysis

Yuan-Lun Hsieh et al. PM R. 2025 May.

Abstract

Objective: To review and synthesize existing evidence on the effect of mirror therapy (MT) on motor and functional recovery and the effect of unimanual and bimanual MT in individuals with subacute stroke.

Methodology: PubMed, Physiotherapy Evidence Database, Cochrane, and Airiti Library were searched for relevant studies. Randomized and pilot randomized controlled trials comparing MT with sham MT or conventional therapy were included. Three researchers independently reviewed eligible studies for study design, participants' characteristics, intervention, and outcome measures and assessed study quality. The Physiotherapy Evidence Database scale was used to evaluate the methodological quality of included studies, and the Cochrane Risk of Bias Tool was used to assess the risk of bias.

Synthesis: Fifteen studies with 546 participants were included. An overall effect of MT was found for motor impairment (effect size [95% confidence interval]: 0.473 [0.274-0.673], p < .001), motor function (0.266 [0.059-0.474], p = .012), and activities of daily living (ADL) (0.461 [0.25-0.671], p < .001), compared with controls. There was a significant difference in motor impairment (0.39 [0.134-0.647], p = .003), motor function (0.298 [0.003-0.593], p = .048), and ADL (0.461 [0.157-0.766], p = .003) in favor of bimanual MT compared with controls. No significant effect was found for unimanual MT.

Conclusion: MT, specifically bimanual MT, is an effective intervention for improving motor recovery, motor function, and ADL in individuals with subacute stroke, whereas unimanual MT does not show significant benefits in these areas.

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Figures

FIGURE 1
FIGURE 1
Flow chart of the study selection process. PEDro, Physiotherapy Evidence Database.
FIGURE 2
FIGURE 2
Risk of bias summary (A) and risk of bias graph (B).
FIGURE 3
FIGURE 3
Forest plots illustrating the effects of mirror therapy, regardless of whether bimanual or unimanual, on motor recovery (A), the effects of bimanual mirror therapy on motor recovery (B), and the effects of unimanual mirror therapy on motor recovery (C). CI, confidence interval; CT, conventional therapy; MMT, movement‐based mirror therapy; MT, mirror therapy; TMT, task‐based mirror therapy.
FIGURE 4
FIGURE 4
Forest plots illustrating the effects of mirror therapy, regardless of whether bimanual or unimanual, on upper limb function (A), the effects of bimanual mirror therapy on upper limb function (B), and the effects of unimanual mirror therapy on upper limb function (C). CI, confidence interval; CT, conventional therapy; MMT, movement‐based mirror therapy; MT, mirror therapy; TMT, task‐based mirror therapy.
FIGURE 5
FIGURE 5
Forest plots illustrating the effects of mirror therapy, regardless of whether bimanual or unimanual, on activities of daily living (A), the effects of bimanual mirror therapy on activities of daily living (B), and the effects of unimanual mirror therapy on activities of daily living (C). CI, confidence interval; CT, conventional therapy; MMT, movement‐based mirror therapy; MT, mirror therapy; TMT, task‐based mirror therapy.
FIGURE 6
FIGURE 6
Forest plots illustrating the effects of mirror therapy on quality of life. CI, confidence interval.
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