https://links.lww.com/PHM/B748

(1)

Table 1 Basic characteristics of the included studies

First author

Ye ar

Type of origin

al resear

ch

Num ber of origin

al studie

s (item

s)

Origi nal study sampl e size (cases

)

Interventions

Risk of bias assessment

tool

Closin g indica

tors

Main Conclusions Experimental

group

Control group

Bai Zhongf

ei ⁹

201 6

RCT 14 433 Mirror therapy

Traditional treatment/ps

eudomirror therapy

PEDro Scale

ad

Mirror therapy improves the motor function of the upper limb on the affected side of the patient with a stroke to a certain extent and

improves the ability to perform daily activities

1

(2)

He Yudi ¹⁰

202 0

RCT 17 731

Mirror visual feedback therapy + treatment with

general rehabilitation/ps

eudomirror

Treatment with general

rehabilitatio n/prosthetic

mirror

PEDro Scale

abc

Mirror visual feedback therapy effectively improves the balance and motor function of

lower limbs in patients with stroke

Hu Yijuan

11

201 9

RCT 14 1165 Mirror therapy

Routine rehabilitatio

n

Cochrane Risk of Bias

Assessment Tool

acd

Mirror therapy improves lower extremity motor function and activities of daily living

in patients with lower extremity dysfunction after stroke Jiao

Fan ¹² 202

0

RCT 16 691 Mirror therapy Noninterven tion or routine

Assessment

abc Mirror therapy may improve lower limb balance and walking ability to some extent

in patients with hemiplegic stroke

(3)

intervention Tool Li

Xinyi

13

201 5

RCT 7 614

Mirror therapy + conventional rehabilitation

n

Assessment Tool

ade

Mirror therapy improves upper extremity motor function and activities of daily living

in patients with stroke

Li Yao

14

202 1

RCT 12 485

Mirror vision feedback therapy/mirror vision feedback

therapy plus traditional rehabilitation

exercises

Traditional rehabilitatio

n exercises

Assessment Tool

ad

Mirror visual feedback therapy improves the motor function of the affected upper

limb and improves the ability of daily living in patients with hemiplegic stroke to

some extent, but it does not significantly improve the hand function and spasticity

status of patients Liu

Gao ¹⁵ 202

0

RCT 14 643 Mirror therapy Convention al treatment

Physical Therapy

abc Mirror therapy improves lower limb motor function and gait to some extent in patients

(4)

Evidence Database

Scale

after stroke, but an improvement in balance still remains to be confirmed by clinical

studies

Peng Juan ¹⁶

201 8

RCT 22 823

Mirror therapy/Mirror

therapy + conventional rehabilitation techniques

Mirrorless visual feedback/co

nventional rehabilitatio

n techniques

Assessment Tool

ade

Mirror therapy improves hemiplegic upper limb function, daily living ability and pain in patients with stroke to some extent, and exerts positive effects on the early, recovery

and poststroke periods, but the long-term sustainability of the efficacy is unclear Wang

Pei ¹⁷

202 1

RCT 15 627 Mirror therapy Negative control

Modified Jadad Scale

abcd Mirror visual feedback training improves limb motor function, walking and balance,

and activities of daily living in patients after stroke

Wu 202 RCT 12 590 Mirror therapy Traditional Cochrane abc Mirror therapy improves lower extremity

(5)

Jing Hua ¹⁸

0

treatment/ps eudomirror

therapy

Risk of Bias Assessment

Tool

motor function and slightly improves balance of patients with stroke; the efficacy

of mirror therapy on walking function still awaits further confirmation

Broder ick ¹⁹

201 8

RCT 9 375

Mirror visual feedback

therapy

Other intervention

s

Assessment Tool

abc

Mirror therapy may exert positive effects on certain lower extremity defects in

patients with stroke

Gandhi

20

202 0

RCT 16 428 Mirror therapy Other

Assessment Tool

a

Mirror therapy is highly effective in improving arm and hand injuries in the

acute poststroke period Li ²¹ 201

8

RCT 13 572 Mirror therapy No

intervention /different

PEDro Scale

ab In addition to some forms of rehabilitation, the use of mirror therapy appears to be

promising for some areas of lower

(6)

intervention /receiving

same intervention

but not mirror image treatment

extremity function, but evidence is not yet sufficient to indicate when and how this

treatment should be administered

Louie

22

201 9

RCT 17 633

therapy + conventional physical therapy

Convention al physical therapy/pse

udomirror therapy

Assessment Tool

abc

Lower extremity mirror therapy exerts a greater effect on improving gait speed and a

small positive effect on mobility and lower extremity motor recovery after stroke Noguei 202 RCT 29 1179 Mirror therapy Pseudomirr PEDro ad Mirror treatment is superior to sham

(7)

ra ²³ 1 or therapy Scale

treatment in terms of recovery of upper extremity movement and activities of daily

living, mainly in the subacute phase

Wang

24

202 0

RCT 6 437

Mirror therapy combined with

electrical stimulation

Convention al treatment/el

ectrical stimulation

Assessment Tool

a

Mirror therapy combined with electrical stimulation exerts a positive effect on lower extremity motor function recovery in stroke

survivors

Zeng ²⁵ 201

8

RCT 11 347

box therapy

n

Assessment Tool

a

Mirror therapy significantly improves upper extremity motor function in patients with

stroke

Table Notes: Outcome indicators: a. motor function: FAM-UE/LE (Fugl-Meyer Motor Function Rating Scale), BBT (box and block test), Brunnstrom Classification, MAS (modified Ashworth scale), ROM and ARAT (upper extremity movement scale); (2) Secondary outcome

2 3

(8)

indicators included: b. balance function: BBS (Berg Balance Scale), MiniBESTest (simple balance rating test), Brunnel Balance Assessment and Biodex Balance System Balance Index; c. walking ability: step length, step width, step frequency, step speed, step length, TUGT (Timed Up and Go Test), FAC (functional ambulation scale) and 10 m walk test; d. activities of daily living ability: ADL, MBI (modified Barthel Index), BI and FIM (functional independence rating); and e. others: VAS (visual analog scale).

4 5 6 7

(9)

Table 2 Results of the AMSTAR2 quality evaluation

First author AMSTAR2 quality evaluation entries

Credibility

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

Bai Zhongfei ⁹ Y N N NY Y Y Y NY Y N Y Y Y Y Y N

Extremely low

He Yudi ¹⁰ Y N N NY Y Y Y NY Y N Y Y Y Y N N

Extremely low

Hu Yijuan ¹¹ Y N N NY Y Y Y NY Y N Y Y Y Y Y N

Extremely low

Jiao Fan ¹² Y N N NY Y Y Y NY Y N Y Y Y Y N N

Extremely low

Li Xinyi ¹³ Y N N NY Y Y Y NY Y N Y Y Y Y Y N

Extremely low

Li Yao ¹⁴ Y N N NY Y Y Y NY Y N Y Y Y N N N

Extremely low

Liu Gao ¹⁵ Y N N NY Y Y Y NY Y N Y Y Y N N N

Extremely low

8

(10)

Peng Juan ¹⁶ Y N N NY Y Y Y NY Y N Y Y Y Y N N

Extremely low

Wang Pei ¹⁷ Y N N NY Y Y NY NY Y N Y N Y Y N N

Extremely low

Wu Jing Hua ¹⁸ Y N N NY Y Y Y NY Y N Y N Y N N N

Extremely low

Broderick ¹⁹ Y N N NY Y Y Y NY Y N Y N N Y Y Y

Extremely low

Gandhi ²⁰ Y N N NY Y Y Y NY Y N Y Y Y Y Y Y Low

Li ²¹ Y N N Y Y Y Y NY Y N Y Y Y Y Y Y Low

Louie ²² Y Y N NY Y Y Y NY Y N Y Y Y Y Y Y Medium

Nogueira ²³ Y N N NY Y Y Y NY Y N Y Y Y N Y Y Low

Wang ²⁴ Y N N NY Y Y Y NY Y N Y Y Y Y Y Y Low

Zeng ²⁵ Y N N NY Y Y Y NY Y N Y Y Y Y Y Y Low

Table notes: "Y" = "Yes"; "NY" = "Partially Yes"; "N" = "No"

9 10 11

(11)

Table 3 Results of GRADE evaluation of the quality of evidence

First author

Inclusi on in

the study

Numb er of cases

Closing indicators

Combined effect volume

95

% CI

Limitati ons

Inconsiste ncy

Indirectn ess

Inaccura cy

Publicati on bias

Quality of Evidence Bai

Zhongf ei ⁹

11 337 FMA-UE

SMD = 0.81

0.43 – 1.20

0 -1^b 0 -1^c -1^d

Very low level

6 161 ARAT

SMD = 0.33

0.01 – 0.64

0 0 0 -1^c 0

Intermedi ate level

4 104 BBT

SMD = 0.70

0.03 – 1.37

0 -1^b 0 -1^c -1^d

Very low level

3 86 Brunnstrom SMD= 1.07 0 0 0 -1^c 0 Intermedi

12

(12)

classification (upper extremity)

1.56

– 2.06

ate level

2 60 MAS

SMD=- 0.22

- 0.73

– 0.28

0 0 0 -1^c -1^d Low level

6 182 FIM

SMD=

0.93

0.62 – 1.24

0 0 0 -1^c 0

Intermedi ate level

2 69 MBI

SMD = 0.50

- 1.61

– 2.01

0 -1^b 0 -1^c -1^d

Very low level

He Yudi ¹⁰

8 268 BBS MD=3.24 0.81

– 5.67

(13)

5 122 TUGT MD=2.68

0.38 – 4.97

7 249 FMA-LE MD=1.65

1.22 – 2.08

6 329 FAC MD=0.41

0.23 – 0.58

6 381

Brunnstrom staging (lower extremity)

MD=0.56

0.33 – 0.80

0 0 0 -1^c 0

Intermedi ate level

3 123 MAS

SMD = 0.07

0.28 – 0.42

0 0 0 -1^c 0

Intermedi ate level

Hu 13 1103 FMA SMD = 0.53 -1^a -1^b 0 0 -1^d Very low

(14)

Yijuan

11

0.80

– 1.07

level

8 523 FAC RR=2.02

1.53 – 2.67

-1^a 0 0 0 -1^d Low level

8 606 MBI

SMD = 0.83

0.67 – 1.00

-1^a 0 0 0 -1^d Low level

Jiao Fan ¹²

10 487

BBS/overall balance index/miniBESTest/B

runnel balance assessment

SMD = 0.98

0.48 – 1.47

-1^a -1^b 0 0 -1^d

Very low level

6 342 FMA-LE MD=4.29

1.82 – 6.76

-1^a -1^b 0 0 -1^d

Very low level

2 235 FAC SMD = 0.35 -1^a 0 0 -1^c -1^d Very low

(15)

0.62

– 0.90

level

7 260 Pace

SMD = 0.89

0.50 – 1.28

-1^a -1^b 0 -1^c -1^d

Very low level

4 153 Step frequency MD=6.69

3.09 – 10.2

8

-1^a 0 0 -1^c -1^d

Very low level

3 71 Stride length MD=6.13

0.24 – 12.0

2

-1^a 0 0 -1^c -1^d

Very low level

4 153 Step length

SMD = 0.80

0.47 – 1.13

-1^a 0 0 -1^c -1^d

Very low level

(16)

Li Xinyi ¹³

4 223 FMA

WMD=8.

30

4.24 – 12.3

6

-1^a -1^b 0 -1^c -1^d

Very low level

2 90 ARAT (4 weeks)

WMD=4.

26

3.03 – 5.50

-1^a -1^b 0 -1^c -1^d

Very low level

2 76 ARAT (6 weeks)

WMD=1.

86

- 3.89

– 7.60

-1^a 0 0 -1^c -1^d

Very low level

2 90 MAS

WMD=0.

93

0.80 – 1.06

-1^a 0 0 -1^c 0 Low level

2 133 BI WMD = 1.82 -1^a 0 0 -1^c -1^d Very low

(17)

4.90

– 7.99

level

2 90 MBI

WMD = 8.48

0.36 – 16.5

9

-1^a -1^b 0 -1^c 0

Very low level

2 113 VAS

WMD = -0.56

- 1.55

– 0.43

-1^a -1^b 0 -1^c -1^d

Very low level

Li Yao

14 12 485 FMA

WMD

=5.24

2.67 – 7.85

-1^a -1^b 0 0 0 Low level

5 208 FIM WMD

=5.20

3.36 – 7.05

-1^a 0 0 -1^c -1^d Very low

level

(18)

3 71 MAS

WMD

=0.08

- 0.06

– 0.22

-1^a 0 0 -1^c -1^d

Very low level

2 70 ARAT

WMD = 4.85

3.19 – 6.51

-1^a 0 0 -1^c -1^d

Very low level

5 253 MBI

WMD = 4.85

3.19 – 6.51

-1^a 0 0 -1^c -1^d

Very low level

3 62

Brunnstrom staging (hand)

WMD = 0.55

- 0.51

– 1.61

-1^a -1^b 0 -1^c -1^d

Very low level

2 50 BBT WMD = 2.88 -1^a 0 0 -1^c -1^d Very low

(19)

5.57

– 8.26

level Liu

Gao ¹⁵ 8 435 FMA

MD = 3.20

1.52 – 4.88

0 -1^b 0 0 -1^d Low level

2 76

Ankle ROM assessment

SMD = 1.20

0.71 – 1.69

3 116 Brunnstrom grading MD=0.55

0.28 – 0.82

3 116 MAS

SMD = 0.79

- 0.62

– 2.21

0 -1^b 0 -1^c -1^d

Very low level

3 112 10 m walking test SMD = 0.03 0 0 0 -1^c -1^d Low level

(20)

0.08

– 0.13

2 112 FAC

SMD = 0.07

- 0.39

– 0.53

2 56

Biodex (overall stability index)

SMD = -0.47

- 1.01

– 0.06

2 56

Biodex Balance System Balance Index

(inner and outer stability index)

SMD = -0.43

- 0.17

– 0.16

2 57 BBS SMD =

0.98

0.42 –

(21)

1.53 Peng

Juan ¹⁶ 13 497 FMA-UE MD=5.39

2.63 – 8.14

0 -1^b 0 0 0

Intermedi ate level

6 228 ARAT MD=3.98

2.64 – 5.31

0 -1^b 0 -1^c -1^d

Very low level

7 236

Brunnstrom classification (upper

extremity)

MD=0.72

0.42 – 1.02

7 378 MBI Score MD=6.11

2.31 – 9.92

0 -1^b 0 -1^c -1^d

Very low level

7 292 VAS SMD=-

1.09

- 1.92

–

0 -1^b 0 -1^c -1^d Very low

level

(22)

0.24 Wang

Pei ¹⁷ 5 185 FMA-UE Rating

WMD=3.

28

0.84 – 5.72

0 -1^b 0 -1^c -1^d

Very low level

8 415 FMA-LE Rating

WMD = 3.62

0.87 – 6.38

0 -1^b 0 0 -1^d Low level

6 281 FAC/10 m walk test

WMD = 0.28

0.15 – 0.42

7 345 BBS

WMD=9.

97

5.08 – 14.8

6

0 -1^b 0 -1^c -1^d

Very low level

4 176 MBI/BI WMD=10

.19

3.64 –

0 -1^b 0 -1^c -1^d Very low

level

(23)

16.7 4 Wu

Jing Hua ¹⁸

5 352 FMA-LE rating MD=5.22

2.65 – 7.79

0 -1^b 0 -1^c -1^d

Very low level

3 116 Brunnstrom grading MD=0.55

0.28 – 0.82

3 148 BBS MD=8.07

0.69 – 16.8

3

0 -1^b 0 -1^c -1^d

Very low level

2 234 mini-BESTest MD=1.49 0.65

– 2.33

0 -1^b 0 -1^c -1^d Very low

level

5 164 10 m walk test MD=0.03 - 0 0 0 -1^c -1^d Low level

(24)

0.04 – 0.11

3 71 TUGT MD=-1.43

- 4.31

– 1.45

Broderi

ck ¹⁹ 4 138

Lower extremity motor function

SMD = 0.59

0.24 – 0.93

-1^a 0 0 -1^c -1^d

Very low level

3 116

Lower extremity muscle tone

MD = -0.08

- 0.35

– 0.18

-1^a 0 0 -1^c -1^d

Very low level

3 78 Balance function SMD = - -1^a 0 0 -1^c -1^d Very low

(25)

-0.55

1.01 – 0.10

level

2 56

Front/rear balance function

SMD = -0.19

- 0.72

– 0.34

-1^a 0 0 -1^c -1^d

Very low level

2 56 Inside/outside balance

SMD = 0.04

- 1.38

– 1.46

-1^a -1^b 0 -1^c -1^d

Very low level

3 85 Functional walking SMD = 0.24

- 0.44

– 0.92

-1^a -1^b 0 -1^c -1^d Very low

level

(26)

4 127 Pace

SMD = 0.71

0.35 – 1.07

-1^a 0 0 -1^c -1^d

Very low level

2 76 Ankle ROM

SMD = 1.20

0.71 – 1.69

-1^a 0 0 -1^c -1^d

Very low level

2 51 Step frequency

SMD = 0.17

- 0.38

– 0.72

-1^a 0 0 -1^c -1^d

Very low level

2 51 Step length

SMD = 0.56

- 0.00

– 1.22

-1^a 0 0 -1^c -1^d

Very low level

2 51 Stride length SMD = - -1^a 0 0 -1^c -1^d Very low

(27)

0.42

0.14 – 0.97

level

Gandhi

20

6 168 FMA MD=2.77

- 1.23

– 6.78

-1^a 0 0 -1^c -1^d

Very low level

3 91 BBT MD=3.61

2.05 – 5.16

-1^a 0 0 -1^c -1^d

Very low level

4 92

Brunnstrom classification (upper

extremity)

MD=0.79

0.05 – 0.54

-1^a -1^b 0 -1^c -1^d

Very low level

3 77

Brunnstrom grading (hand)

MD=1.41

0.80 – 0.21

-1^a 0 0 -1^c -1^d

Very low level

(28)

Li ²¹

7 280 Traveling speed MD=0.1

0.08 – 0.12

-1^a 0 0 -1^c -1^d

Very low level

4 124 ROM

SMD = 0.43

- 0.12

– 0.98

-1^a -1^b 0 -1^c -1^d

Very low level

6 322 Balance function

SMD = 0.66

0.43 – 0.88

-1^a 0 0 -1^c -1^d

Very low level

7 373

Lower extremity motor function

recovery

SMD = 0.83

0.62 – 1.05

-1^a 0 0 -1^c -1^d

Very low level

3 109 Ankle MAS MD =

-0.14

- 0.43

-1^a 0 0 -1^c -1^d Very low

level

(29)

– 0.15

2 76 Ankle ROM MD=2.07

0.82 – 3.32

-1^a -1^b 0 -1^c -1^d

Very low level Louie ²²

6 188 Pace MD=1.04

0.43 – 1.66

-1^a -1^b 0 -1^c -1^d

Very low level

4 123

Pace (combined with physical therapy)

SMD=1.5 8

0.60 – 2.56

-1^a -1^b 0 -1^c -1^d

Very low level

5 146

Movement (walking independence/motor

tasks/transfer)

SMD = 0.46

0.01 – 0.90

-1^a 0 0 -1^c -1^d

Very low level

4 103 Balance function SMD =

0.69

- 0.08

-1^a -1^b 0 -1^c -1^d Very low

level

(30)

– 1.46

7 234 Motion function

SMD = 0.47

0.21 – 0.74

-1^a 0 0 -1^c -1^d

Very low level

Noguei ra ²³

7 269 UL Evaluation MD=0.32

- 0.02

– 0.66

-1^a 0 0 -1^c -1^d

Very low level

7 269 ADL MD=0.30

- 0.14

– 0.75

-1^a 0 0 -1^c -1^d

Very low level

Wang ²⁴ 5 353 FMA-LE MD=5.63 4.86

– 6.39

-1^a 0 0 -1^c -1^d Very low

level

(31)

3 272 Brunnstrom grading

WMD=0.

49

0.32 – 0.66

-1^a -1^b 0 -1^c -1^d

Very low level

Zeng ²⁵ 11 347

Upper extremity motor function

SMD = 0.51

0.29 – 0.73

-1^a -1^b 0 -1^c 0

Very low level Notes: "0" indicates no downgrade, "-1" indicates a downgrade, "NA" indicates missing data; "^a " indicates some deficiencies in the methodological quality of the included studies, "^b " indicates that I² >50% for the included studies, "^c " indicates a small included sample size and a wide confidence interval for the combined effect size, " ^d" indicates an asymmetric funnel plot or inclusion of less than 9 studies.

13 14 15 16