The Efficacy of Mirror Therapy for Improving Balance and Gait Post-Stroke: A Systematic Review

Background: Mirror therapy is less commonly used to target the lower extremity after stroke to improve outcomes but is simple to perform. This review and meta-analysis aimed to evaluate the efficacy of lower extremity mirror therapy in improving balance, gait, and motor function for individuals with stroke. Methods: PubMed, Cochrane Central Register of Controlled Trials, MEDLINE, Embase, CINAHL, PEDro, and PsychINFO were searched from inception to May 2018 for randomized controlled trials (RCTs) comparing lower extremity mirror therapy to a control intervention for people with stroke. Pooled effects were determined by separate meta-analyses of gait speed, mobility, balance, and motor recovery. Results: Seventeen RCTs involving 633 participants were included. Thirteen studies reported a significant between-group difference favouring mirror therapy in at least one lower extremity outcome. In a meta-analysis of six trials that reported change in gait speed, a large beneficial effect was observed following mirror therapy training (SMD = 1.04 [95% CI = 0.43, 1.66], I2 = 73%, p<0.001). Lower extremity mirror therapy also had a positive effect on mobility (5 studies, SMD = 0.46 [95% CI = 0.01, 0.90], I2 = 43%, p = 0.05) and motor recovery (7 studies, SMD = 0.47 [95% CI = 0.21, 0.74], I2 = 0%, p<0.001). A significant pooled effect was not found for balance capacity. Conclusions: Mirror therapy for the lower extremity has a large effect for gait speed improvement. This review also found a small positive effect of mirror therapy for mobility and lower extremity motor recovery after stroke.