Effects of Mirror Therapy in Stroke Patients With Complex Regional Pain Syndrome Type 1: A Randomized Controlled Study

Arch Phys Med Rehabil. 2016 Apr;97(4):575-581. doi: 10.1016/j.apmr.2015.12.008. Epub 2015 Dec 23.


Objective: To investigate the effects of mirror therapy on upper limb motor functions, spasticity, and pain intensity in patients with hemiplegia accompanied by complex regional pain syndrome type 1.

Design: Randomized controlled trial.

Setting: Training and research hospital.

Participants: Adult patients with first-time stroke and simultaneous complex regional pain syndrome type 1 of the upper extremity at the dystrophic stage (N=30).

Interventions: Both groups received a patient-specific conventional stroke rehabilitation program for 4 weeks, 5 d/wk, for 2 to 4 h/d. The mirror therapy group received an additional mirror therapy program for 30 min/d.

Main outcome measures: We evaluated the scores of the Brunnstrom recovery stages of the arm and hand for motor recovery, wrist and hand subsections of the Fugl-Meyer Assessment (FMA) and motor items of the FIM-motor for functional status, Modified Ashworth Scale (MAS) for spasticity, and visual analog scale (VAS) for pain severity.

Results: After 4 weeks of rehabilitation, both groups had significant improvements in the FIM-motor and VAS scores compared with baseline scores. However, the scores improved more in the mirror therapy group than the control group (P<.001 and P=.03, respectively). Besides, the patients in the mirror therapy arm showed significant improvement in the Brunnstrom recovery stages and FMA scores (P<.05). No significant difference was found for MAS scores.

Conclusions: In patients with stroke and simultaneous complex regional pain syndrome type 1, addition of mirror therapy to a conventional stroke rehabilitation program provides more improvement in motor functions of the upper limb and pain perception than conventional therapy without mirror therapy.

Keywords: Complex regional pain syndromes; Hemiplegia; Pain; Rehabilitation; Therapeutics.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Aged
  • Female
  • Functional Laterality / physiology*
  • Hemiplegia / etiology
  • Hemiplegia / physiopathology
  • Hemiplegia / rehabilitation*
  • Humans
  • Male
  • Middle Aged
  • Muscle Spasticity / etiology
  • Muscle Spasticity / physiopathology
  • Muscle Spasticity / rehabilitation
  • Muscle, Skeletal / physiopathology
  • Pain / etiology
  • Pain / physiopathology
  • Pain / rehabilitation
  • Pain Measurement
  • Physical Therapy Modalities*
  • Recovery of Function / physiology
  • Reflex Sympathetic Dystrophy / complications
  • Reflex Sympathetic Dystrophy / physiopathology
  • Reflex Sympathetic Dystrophy / rehabilitation*
  • Stroke / complications
  • Stroke / physiopathology
  • Stroke Rehabilitation*
  • Treatment Outcome
  • Upper Extremity / physiopathology