Date Presented 04/04/19
Mirror therapy (MT) is an evidence-based intervention for upper-extremity (UE) hemiparesis after stroke; however, few MT studies have utilized task-based activities. An RCT was conducted comparing subjects with UE hemiparesis poststroke who performed task-based MT (n=5) and exercise-based MT (n=3). Preliminary results have found significant improvement in all subjects on the COPM, ARAT, and SF-36, but no differences have been found between the two groups. Additional data is being collected.
Primary Author and Speaker: Nakisha Gutierrez
Additional Authors and Speakers: Mary Hildebrand
Contributing Authors: Cora Finley
PURPOSE: Mirror therapy (MT) is an evidenced-based intervention for upper extremity (UE) hemiparesis after stroke1, 2; however, studies have primarily used an exercise MT protocol and few have utilized task-based activities.3This studycompared task-based MT intervention with a rote exercise-based MT intervention for clients with UE hemiparesis after stroke.
DESIGN: We used a single blinded, randomized two-group pretest-posttest research design to compare the effectiveness of task-based MT and non-task based MT. A convenience sample of 8 subjects were randomly assigned to either a task-based (n=5) or exercise-based (n=3) MT group. The study included adults who were at least six-months post-stroke with hemiparesis, visually detectable UE AROM, and a score > 24 on the MMSE.
METHODS: A detailed study protocol manual was created and given to all trained interventionists. To ensure treatment fidelity, a checklist was developed and completed in 2 randomized sessions per subject by a trained rater. Subjects participated in 30 minutes of MT followed by 30 minutes of standard OT once per week for 8 weeks. Participants also completed a home exercise program (HEP) of 5 or more exercises or tasks to be completed the other 6 days per week. Each subject received a mirror box and weekly HEP activities. Pre- and post- outcomes measures included theAction Research Arm Test (ARAT) to assess change in functional movement over four domains: grasp, grip, pinch & gross movement; the 36-Item Short Form Health Survey (SF-36) to measure self-reported change in quality of life; the Disabilities of the Arm Shoulder and Hand (DASH) to measure changes in self-reported function in a variety of occupations, and the Canadian Occupational Performance Measure (COPM) to assess change in a client’s self-perception of occupational performance. With the small sample size, data was analyzed with the Mann-Whitney U and Wilcoxon Signed Rank Tests.
RESULTS: Preliminary results indicate that all subjects (n=8) had significant improvements on COPM Performance (.034) and Satisfaction (p=.008), ARAT (p=.034), and SF-36 (physical, p=.034; social functioning, p=.034) after MT. Subjects reported good compliance with the MT HEP and successfully returned exercise/task logs each week. However, there was no significant difference found between the task-based group (n=5) and the exercise-based group (n=3) on outcomes measures. The treatment fidelity checklist indicated that interventionists maintained adherence to the MT protocol over time, but showed no significant difference between task-based and exercise-based protocols (p=.057).
CONCLUSIONS: Past MT studies have found that it is an effective intervention for adults who have hemiparesis after stroke. Our preliminary data analysis supports MT efficacy, but does not find either task-based or exercise-based MT more effective. Subjects in the task-based group reported using their arm more often and that their arm felt more normal; while the exercise-based subjects reported some boredom with the exercises. The lack of a significant difference on treatment fidelity between the two groups by the interventionists is a concern. However, the small sample size is a major limitation that may be overcome as the study gains more participants.
IMPACT STATEMENT: MT is an effective intervention for UE hemiparesis after stroke, a common and challenging condition.1, 2 It is easy and inexpensive and may be monitored in the clinic and carried out in the home. Finding the most efficacious protocol for MT is vital for implementation and, ultimately, mitigating hemiparesis after stroke.
References
1. Nilsen, D. M., Gillen, G., Geller, D., Hreha, K., Osei, E., & Saleem, G. T. (2015). Effectiveness of interventions to improve occupational performance of people with motor impairments after stroke: An evidence-based review. American Journal of Occupational Therapy, 69(1), 6901180030p1-6901180030p9
2. Thieme, H., Mehrholz, J., Pohl, M., Behrens, J., & Dohle, C. (2012). Mirror therapy for improving motor function after stroke. The Cochrane Database of Systematic Reviews, 3(3), CD008449. doi:10.1002/14651858.CD008449.pub2
3. Arya, K. N., Verma, R., Garg, R. K., Sharma, V. P., Agarwal, M., & Aggarwal, G. G. (2012). Meaningful task-specific training (MTST) for stroke rehabilitation: A randomized controlled trial. Topics in Stroke Rehabilitation, 19(3), 193-211. doi:10.1310/tsr1903-193
