Phase II Pragmatic Randomized Controlled Trial of Patient-Led Therapies (Mirror Therapy and Lower-Limb Exercises) During Inpatient Stroke Rehabilitation

Your insurance will love this, no therapist payments needed. You'll be on your own. Send your doctor after the mirror therapy protocol and get it publicly published.
http://nnr.sagepub.com/content/29/9/818?etoc

1. Sarah Tyson, PhD1,2
2. Jack Wilkinson, MSc1,3
3. Nessa Thomas1,2
4. Ruud Selles, PhD4
5. Candy McCabe, PhD5
6. Pippa Tyrrell, MD1,3
7. Andy Vail, MSc1,3

1. ¹University of Manchester, Manchester, UK
2. ²School of Nursing Midwifery & Social Word, Manchester, UK
3. ³Salford Royal NHS Foundation Trust, UK
4. ⁴Erasmus MC, Rotterdam, the Netherlands
5. ⁵University of the West England, Bristol and Royal National Hospital for Rheumatic Diseases NHS Foundation Trust, Bath, UK

1. Sarah Tyson, PhD, Stroke Research Centre, University of Manchester, Jean McFarlane Building, Oxford Rd, Manchester M13 9PL, UK. Email: Sarah.tyson@manchester.ac.uk

Abstract

Background and objective. Patient-led therapy has the potential to increase the amount of therapy patients undertake during stroke rehabilitation and to enhance recovery. Our objective was to assess the feasibility and acceptability of 2 patient-led therapies during the acute stages of stroke care: mirror therapy for the upper limb and lower-limb exercises for the lower limb. 

Methods. This was a blind assessed, multicenter, pragmatic randomized controlled trial of patient-led upper-limb mirror therapy and patient-led lower leg exercises. Stroke survivors with upper and lower limb limitations, undergoing inpatient rehabilitation and able to consent were recruited at least 1 week poststroke.  

Results. Both interventions proved feasible, with >90% retention. No serious adverse events were reported. Both groups did less therapy than recommended; typically 5 to 15 minutes for 7 days or less. Participants receiving mirror therapy (n = 63) tended to do less practice than those doing lower-limb exercises (n = 31). Those with neglect did 69% less mirror therapy than those without (P = .02), which was not observed in the exercise group. Observed between-group differences were modest but neglect, upper-limb strength, and dexterity showed some improvement in the mirror therapy group. No changes were seen in the lower-limb group. 

Conclusions. Both patient-led mirror therapy and lower-limb exercises during inpatient stroke care are safe, feasible, and acceptable and warrant further investigation. Practice for 5 to 15 minutes for 7 days is a realistic prescription unless strategies to enhance adherence are included.