Improving upper extremity motor function in stroke patients using a complex task with multi-joint-based mirror therapy: A randomized controlled trial

Background & Objective: Mirror therapy has been shown to be effective in restoring upper extremity function in stroke patients through changes in the central nervous system. Therefore, it is important to evaluate the effectiveness of various tasks to induce central nervous system excitation. This study investigated the effect of using a complex task with multi-joint-based mirror therapy on upper extremity function and activities of daily living (ADL) in patients with hemiplegia after a stroke. Methods: In this study, 25 stroke patients were recruited and assigned randomly to the experimental or control group. The experimental group received a complex task using multi-joint-based mirror therapy, and the control group received a simple task using single-joint-based mirror therapy. Both groups received the same standard rehabilitation treatment 5 days per week for 4 weeks. An upper extremity evaluation was performed using the Fugl-Meyer Assessment (FMA) and Motor Activity log (MAL). The FMA includes an upper extremity subsection (FMA-UE) as well as upper arm (FMA-UA) and wrist/hand (FMA-WH) subparts. The MAL includes quality of movement (QOM) and amount of use (AOU) subsections. ADL were evaluated using the Korean version of the Modified Barthel Index (K-MBI). Results: Compared with the control group, the experimental group showed greater improvement on the FMA-UE, -UA, and -WH (p = 0.034, 0.047, and 0.013, respectively); MAL-AOU and -QOM (p = 0.048 and 0.034, respectively); and K-MBI (p = 0.031). The following effect sizes (Cohen's d) were observed: FMA-UE, -UA, and -WH (1.0); MAL-AOU (0.2); MAL-QOM (1.6); and K-MBI (0.2). Conclusions: This study demonstrates that a complex task using multi-joint-based mirror therapy is more effective in restoring upper limb function and ADL in stroke patients than simple task-based mirror therapy.