Effects of Mirror Therapy on Motor Recovery Following a Stroke: A Meta-Analysis

거울치료가 뇌졸중 환자의 운동기능 회복에 미치는 영향: 메타분석

  • Lee, Hee-Won (Dept. of Physical Therapy, The Graduate School, Yonsei University) ;
  • Jeon, Hye-Seon (Dept. of Physical Therapy, College of Health Science, Yonsei University/Dept. of Ergonomic Therapy, The Graduate School of Health and Environment, Yonsei University)
  • 이희원 (연세대학교 대학원 물리치료학과) ;
  • 전혜선 (연세대학교 보건과학대학 물리치료학과, 보건환경대학원 인간공학치료학과)
  • Received : 2012.01.25
  • Accepted : 2012.03.13
  • Published : 2012.05.21


The objective of this study was to evaluate the effects of mirror therapy on motor function recovery following a stroke through a systemic review and meta-analysis. In total, nine of the 48 studies were identified from search engines between 1997 and 2011, as well as from a review of the reference lists of each identified study. The quality of each study was assessed using Jadad scale, and the effect size was calculated as a Cohen's effect size using MetaAnalyst (Beta 3.13). The overall effect size of the mirror therapy was 2.005 (95% confidence interval=1.041~2.970) in a random-effects model. This finding suggests that mirror therapy is beneficial for improving motor function following a stroke. The results from the subgroup analysis according to categorical variables were as follows: First, the effect size was larger for an onset time of less than 1 year (1.166) than for a duration of 1 year or more (.668). Second, the effect size of unpublished dissertations (1.610) was larger than published articles (1.221). Third, motor recovery of upper extremities (1.609) had a greater effect than motor recovery of lower extremities (.903). The major limitation of this study is the relatively small study population. Therefore, further individual studies of mirror therapy should be conducted in order to generalize the effects. In addition, mirror therapy supervised by a physical therapist should be recognized as a potential approach to manage motor function following a stroke and recommended to patients to improve their motor function.


  1. 박상범, 김미현. 뇌졸중 환자의 재활을 위한 인지적 중재전략으로서의 운동심상과 활동관찰. 서울, 한국특수체육학회지. 2005;13(2):109-120.
  2. 박소연, 신인수. 국내 노인을 대상으로 한 낙상예방 운동프로그램이 근력증가에 미치는 효과: 메타분석. 한국전문물리치료학회지. 2011;18(3):38-48.
  3. 백남영. 거울치료가 편마비환자의 하지 기능에 미치는 영향. 대구대학교 재활과학대학원, 석사학위논문, 2009:1-45.
  4. 오성삼. 선행연구 결과의 통합과 재분석을 위한 메타분 석의 이론과 실제. 서울, 건국대학교출판부, 2002:14-15.
  5. 우희순, 장기연, 박우권. 거울치료가 만성 뇌졸중 환자의 손 기능 회복에 미치는 영향. 대한작업치료학회지. 2011;19(1):93-103.
  6. 유수전, 황기철, 김희정, 등. 거울매개치료가 뇌졸중 후 편마비 환자의 상지기능과 일상생활활동에 미치는 영향. 대한작업치료학회지. 2011;19(2):25-37.
  7. 이명모. 거울치료프로그램이 급성 뇌졸중 환자의 상지 운동회복과 운동기능에 미치는 영향. 삼육대학교 대학원, 석사학위논문, 2010:1-71.
  8. 이준영. 메타분석. 서울, 대한내분비학회지. 2008;23(6): 361-378.
  9. 이충휘. 물리치료사와 작업치료사를 위한 연구방법론. 3판. 서울, 계축문화사, 2007:367-376.
  10. Altschuler EL, Hu J. Mirror therapy in a patient with a fractured wrist and no active wrist extension. Scand J Plast Reconstr Surg Hand Surg. 2008;42(2):110-111.
  11. Altschuler EL, Wisdom SB, Stone L, et al. Rehabilitation of hemiparesis after stroke with a mirror. Lancet. 1999;353(9169):2035-2036.
  12. Basmajian JV, Gowland C, Brandstater ME et al. EMG feedback treatment of upper limb in hemiplegic stroke patients: A pilot study. Arch Phys Med Rehabil. 1982;63(12):613-616.
  13. Blanton S, Wolf SL. An application of upper-extremity constraint-induced movement therapy in a patient with subacute stroke. Phys Ther. 1999;79(9):847-853.
  14. Cacchio A, De Blasis E, De Blasis V, et al. Mirror therapy in complex regional pain syndrome type 1 of the upper limb in stroke patients. Neurorehabil Neural Repair. 2009;23(8):792-799.
  15. Carson RG. Neural pathways mediating bilateral interactions between the upper limbs. Brain Res Brain Res Rev. 2005;49(3):641-662.
  16. Cohen J. Statistical Power Analysis for the Behavioral Science. 2nd ed, Hillsdale, NJ, Lawrence Erlbaum Associates. 1988:24-40.
  17. Cook DJ, Mulrow CD, Haynes RB. Systematic reviews: Synthesis of best evidence for clinical decisions. Ann Intern Med. 1997;126(5):376-380.
  18. Cooper HM. Scientific guidelines for conducting integrative research review. Rev Educ Res. 1982;52(2):291-302.
  19. Dijkerman HC, Ietswaart M, Johnston M, et al. Does motor imagery training improve hand function in chronic stroke patients? A pilot study. Clin Rehabil. 2004;18(5):538-549.
  20. Dohel C, Püllen J, Nakaten A, et al. Mirror therapy promotes recovery from severe hemiparesis: A randomized controlled trial. Neurorehabil Neural Repair. 2009;23(3):209-217.
  21. Dunsky A, Dickstein R, Marcovitz E, et al. Home-based motor imagery training for gait rehabilitation of people with chronic poststroke hemiparesis. Arch Phys Med Rehabil. 2008;89(8):1580-1588.
  22. Ezendam D, Bongers RM, Jannink MJ. Systematic review of the effectiveness of mirror therapy in upper extremity function. Disabil Rehabil. 2009;31(26):2135-2149.
  23. Feys H, Hetebrij1 J, Wilms G, et al. Predicting arm recovery following stroke: Value of site of lesion. Acta Neurol Scand. 2000;102(6):371-377.
  24. Garry ML, Loftus A, Summers JJ. Mirror, mirror on the wall: Viewing a mirror reflection of unilateral hand movements facilitates ipsilateral M1 excitability. Exp Brain Res. 2005;163(1):118-22.
  25. Grunert-Plüss N, Hufschmid U, Santschi L, et al. Mirror therapy in hand rehabilitation: A review of the literature, the St Gallen protocol for mirror therapy and evaluation of a case series of 52 patients. Hand Ther. 2008;13(1):4-11.
  26. Guillot A, Collet C. Contribution from neurophysiological and psychological methods to the study of motor imagery. Brain Res Brain Res Rev. 2005;50(2):387-397.
  27. Hartman-Maeir A, Soroker N, Oman SD, et al. Awareness of disabilities in stroke rehabilitation- a clinical trial. Disabil Rehabil. 2003;25(1):35-44.
  28. Hedges LV, Olkin I. Statistical Methods for Meta-analysis. San Diego, CA, Academic Press. 1985:78-80.
  29. Hendricks HT, van Limbeek J, Geurts AC, et al. Motor recovery after stroke: A systematic review of the literature. Arch Phys Med Rehabil. 2002;83(11):1629-1637.
  30. Hu XL, Tong KY, Song R, et al. A comparison between electromyography-driven robot and passive motion device on wrist rehabilitation for chronic stroke. Neurorehabil Neural Repair. 2009;23(8):837-846.
  31. Jackson PL, Lafleur MF, Malouin F, et al. Potential role of mental practice using motor imagery in neurologic rehabilitation. Arch Phys Med Rehabil. 2001;82(8):1133-1141.
  32. Jadad AR, Moore RA, Carroll D, et al. Assessing the quality of reports of randomized clinical trials: Is blinding necessary? Control Clin Trials. 1996;17(1):1-12.
  33. Karmarkar A, Lieberman I. Mirror box therapy for complex regional pain syndrome. Anaesthesia. 2006;61(4):412-413.
  34. Kerlikowske K, Grady D, Rubin SM, et al. Efficacy of screening mammography: A meta-analysis. JAMA 1995;273(2):149-154.
  35. LeLorier J, Grégoire G, Benhaddad A, et al. Discrepancies between meta-analyses and subsequent large randomized, controlled trials. N Engl J Med 1997;337(8):536-542.
  36. McCobe CS, Haigh RC, Ring EF, et al. A controlled pilot study of the utility of mirror visual feedback in the treatment of complex regional pain syndrome (type 1). Oxford, Rheumatology. 2003;42(1):97-101.
  37. Michielsen ME, Selles RW, van der Geest JN, et al. Motor recovery and cortical reorganization after mirror therapy in chronic stroke patients: A phase II randomized controlled trial. Neurorehabil Neural Repair. 2011;25(3)223-233.
  38. Olney SJ, Richards CL. Hemiparetic gait following stroke, part I: characteristics. Gait Posture. 1996;4:136-148.
  39. Perry J, Garrett M, Gronley JK, et al. Classification of walking handicap in stroke population. Stroke. 1995;26(6):982-989.
  40. Ramachandran VS, Rogers-Ramachandran D. Synaesthesia in phantom limbs induced with mirrors. Proc Bilo Sci. 1996;263(1369):377-386.
  41. Riccio I, Iolascon G, Barillari MR, et al. Mental practice is effective in upper limb recovery after stroke: A randomized single-blind cross-over study. Eur J Phys Rehabil Med. 2010;46(1):19-25.
  42. Rosen B, Lundborg G. Training with a mirror in rehabilitation of the hand. Scand J Plast Reconstr Surg Hand Surg. 2005;39(2):104-108.
  43. Rosenfeld RM, Post JC. Meta-analysis of antibiotics for the treatment of otitis media with effusion. Otolaryngol Head Neck Surg. 1992;106(4):378-386.
  44. Ryerson S, Levit K. Functional Movement Reeducation: A contemporary model for stroke rehabilitation. New York, Churchill Livingstone. 1997:1-13.
  45. Sathian K, Greenspan AI, Wolf SL. Doing it with mirrors: A case study of a novel approach to neurorehabilitation. Neurorehabil Neural Repair. 2000;14(1):73-76.
  46. Shumway-Cook A, Silver IF, LeMier M, et al. Effectiveness of a community-based multifactorial intervention on falls and fall risk factors in community-living older adults: A randomized, controlled trial. J Gerontol A Biol Sci Med Sci. 2007;62(12):1420-1427.
  47. Smart CR, Hendrick RE, Rutledge JH 3rd, et al. Benefit of mammography screening in women ages 40 to 49 years: Current evidence from randomized controlled trials. Cancer. 1995;75(7): 1619-1626.<1619::AID-CNCR2820750711>3.0.CO;2-T
  48. Stevens JA, Stoykov ME. Using motor imagery in the rehabilitation of hemiparesis. Arch Phys Med Rehabil. 2003;84(7):1090-1092.
  49. Sutbeyaz S, Yavuzer G, Sezer N, et al. Mirror therapy enhances lower-extremity motor recovery and motor functioning after stroke: A randomized controlled trial. Arch Phys Med Rehabil. 2007;88(5):555-559.
  50. Thirumala P, Hier DB, Patel P. Motor recovery after stroke: Lessons from functional brain imaging. Neurol Res. 2002;24(5):453-458.
  51. Williams RL, Chalmers TC, Strange KC, et al. Use of antibiotics in preventing recurrent acute otitis media and in treating otitis media with effusion: A meta-analytic attempt to resolve the brouhaha. JAMA 1993;270(11):1344-1351.
  52. Yavuzer G, Selles R, Sezer N, et al. Mirror therapy improves hand function in subacute stroke: A randomized controlled trial. Arch Phys Med Rehabil. 2008;89(3):393-398.