MEDIAN Klinik Berlin-Kladow, Berlin, Germany.
Center for Stroke Research Berlin, Charité - University Medicine Berlin, Berlin, Germany.
Restor Neurol Neurosci. 2019;37(5):421-435. doi: 10.3233/RNN-190935.
A recently updated Cochrane review for mirror therapy (MT) showed a high level of evidence in the treatment of hemiparesis after stroke. However, the therapeutic protocols used in the individual studies showed significant variability.
A secondary meta-analysis was performed to detect which parameters of these protocols may influence the effect of MT for upper limb paresis after stroke.
Trials included in the Cochrane review, which published data for motor function / impairment of the upper limb, were subjected to this analysis. Trials or trial arms that used MT as group therapy or combined it with electrical or magnetic stimulation were excluded. The analysis focused on the parameters mirror size, uni- or bilateral movement execution, and type of exercise. Data were pooled by calculating the total weighted standardized mean difference and the 95% confidence interval.
Overall, 32 trials were included. The use of a large mirror compared to a small mirror showed a higher effect on motor function. Movements executed unilaterally showed a higher effect on motor function than a bilateral execution. MT exercises including manipulation of objects showed a minor effect on motor function compared to movements excluding the manipulation of objects. None of the subgroup differences reached statistical significance.
The results of this analysis suggest that the effects on both motor function and impairment of the affected upper limb depend on the therapy protocol. They furthermore indicate that a large mirror, unilateral movement execution and exercises without objects may be parameters that enhance the effects of MT for improving motor function after stroke.
最近更新的 Cochrane 综述显示镜像疗法（MT）在治疗中风后偏瘫方面具有较高的证据水平。然而，各研究中使用的治疗方案存在显著差异。
进行二次荟萃分析以检测这些方案中的哪些参数可能影响 MT 治疗中风后上肢瘫痪的效果。
对发表上肢运动功能/损伤数据的 Cochrane 综述中的试验进行了此项分析。排除将 MT 用于团体治疗或与电或磁刺激联合使用的试验或试验臂。分析重点是镜子大小、单侧或双侧运动执行以及运动类型等参数。通过计算总加权标准化均数差和 95%置信区间来汇总数据。
共有 32 项试验纳入分析。与小镜子相比，大镜子的使用对运动功能的影响更大。单侧运动比双侧运动的效果更好。与不包括物体操作的运动相比，包括物体操作的 MT 运动对运动功能的影响较小。但这些亚组差异均未达到统计学意义。
这项分析结果表明，对运动功能和受影响上肢损伤的影响取决于治疗方案。此外，大镜子、单侧运动执行和无物体的运动可能是增强 MT 改善中风后运动功能效果的参数。
