Effectiveness of mirror therapy for the lower extremity in patients after stroke - literature review

Uvod: Možganska kap je nevrološka motnja, ki povzroči motorične in senzorične okvare spodnjega uda ter omejitev številnih vsakodnevnih dejavnosti. V zadnjem času se terapija z ogledalom uveljavlja kot eden izmed terapevtskih postopkov, s katerimi bi lahko izboljšali nekatere telesne funkcije in funkcioniranje pacientov po možganski kapi. Namen: Pregledati in analizirati izsledke raziskav o učinkovitosti terapije z ogledalom za spodnji ud pri pacientih po možganski kapi. Metode dela: Znanstvene raziskovalne članke smo iskali v podatkovnih zbirkah PEDro, PubMed in CINAHL. V pregled literature smo zajeli randomizirane kontrolirane poskuse, objavljene v angleškem jeziku do vključno marca 2022. Rezultati: V pregled literature je bilo vključenih sedem raziskav, objavljenih med letoma 2007 in 2018 z ocenami po lestvici PEDro med 4 in 7. Skupno je bilo v raziskavah zajetih 212 pacientov po možganski kapi. V vseh raziskavah so terapijo z ogledalom primerjali s placebo terapijo z ogledalom ali z enako vadbo brez ogledala. Rezultati ene raziskave kažejo na učinkovitost terapije z ogledalom za spodnji ud za izboljšanje trajanja enojne opore na okvarjeni spodnji ud med hojo, rezultati druge raziskave pa na izboljšanje funkcijske neodvisnosti. Rezultati raziskav o učinkovitosti terapije z ogledalom za povečanje obsega gibljivosti dorzalne fleksije gležnja, izboljšanje hitrosti hoje, dolžine koraka in dvojnega koraka, motoričnih funkcij spodnjega uda ter sposobnosti hoje so neenotni, medtem ko se obravnavana terapija ni izkazala kot učinkovita za izboljšanje mišičnega tonusa plantarnih fleksorjev, kadence, širine koraka, trajanje faze opore in faze zamaha ter ravnotežja. Zaključek: Nakazuje se, da bi terapija z ogledalom za spodnji ud lahko bila učinkovita za povečanje obsega gibljivosti dorzalne fleksije gležnja, izboljšanje motoričnih funkcij spodnjega uda, nekaterih časovnih in dolžinskih spremenljivk hoje ter sposobnosti hoje in funkcijske neodvisnosti pacientov po možganski kapi, če se začne izvajati v akutni ali subakutni fazi kot dodatek k standardni fizioterapiji in traja vsaj štiri tedne, petkrat na teden 15–30 minut. Potrebne so nadaljnje raziskave o učinkovitosti terapije z ogledalom za spodnji ud za izboljšanje dejavnosti in sodelovanja ter njeni dolgoročni učinkovitosti pri pacientih v vseh fazah po možganski kapi.Introduction: Stroke is a neurological disorder that leads to motor and sensory impairments of the lower extremity and limitations of various activities of daily living. In recent years, mirror therapy has been used as a complementary therapeutic method to help improve some of the body functions and functioning of stroke patients. Purpose: To review and analyze the results of randomized controlled trials on the effectiveness of mirror therapy for the lower extremity in stroke patients. Methods: PubMED, PEDro and CINAHL databases were used for the literature search. Only randomized controlled trials published in English before March 2022 were reviewed. Results: The literature review included seven studies published between 2007 and 2018 that had PEDro scores between 4 and 7. A total of 212 stroke patients were included in the studies. In all studies, mirror therapy was compared with sham mirror therapy or with the same therapy without a mirror. The results of one study show that mirror therapy for the lower extremity is effective in improving single stance duration on the affected side during gait while another study proved its effectiveness in improving functional independence. Results of the studies on the effectiveness of mirror therapy in improving ankle dorsiflexion range of motion, gait velocity, step and stride length, lower extremity motor functions and gait ability were inconsistent. The therapy was not effective in improving plantar flexor muscle tone, cadence, step width, stance and swing phase duration and balance. Conclusion: Mirror therapy for the lower extremity may be effective in improving ankle dorsiflexion range of motion, lower extremity motor functions, some of the temporal and spatial gait characteristics, gait ability and functional independence of stroke patients, but it should be started in the acute or subacute phase as a complementary therapy to standard physiotherapy at least four weeks, five times a week for 15 to 30 minutes. Further studies are needed on the effectiveness of mirror therapy for the lower extremity in improving activities and participation as well as its long-term effectiveness in all phases after stroke