Comparison of Electrical Stimulation and Mirror Therapy and Conventional Rehabilitation and Combining them for Rehabilitation of Upper Extremity in Stroke Patients: A Meta-Analysis

  The most common functional disorders in stroke patients are disabilities in reaching and manipulation tasks which are associated with many problems for doing daily activities. Despite multiple techniques in rehabilitation, the amount and rate of recovery of upper extremity motor functions are weak, so new strategies have been suggested for combining different therapy methods. With the assumption that further improvement achieved through the use of both cognitive and physical aspects in the reorganization of neural circuits in the brain, in the rehabilitation of affected limb, the combination of mirror therapy and electrical stimulation can be more effective than using each of these methods separately. In the present study, we compared electrical stimulation and mirror therapy and conventional therapy and combination therapy in a pre-test/post-test study. A systematic review with meta-analysis was performed on mirror therapy, electrical stimulation, and their combination from Pedro, Pubmed, and Rehabdata databases. A meta-analysis was performed based on random effect and effect size was obtained with the standard mean difference. The acute or sub-acute and chronic stroke, active/passive stimulation, and also protocol of training exercises in coordinated bilateral movement and other exercises are considered as affecting factors. In the present study, 35 articles with 903 stroke patients were studied. A significant difference was observed in comparing the efficacy of the two methods of mirror therapy and electrical stimulation and a conventional therapy. Also, a significant difference was confirmed between efficacies of pre-test/post-test in conventional therapy. Therewith, the existence of significant difference was confirmed between treatments of the early and late duration of the stroke. The type of active and passive stimulation, as well as bimanual or bilateral exercise movements in comparison with other exercise movements did not reveal a significant difference between the efficacy of electrical stimulation and mirror therapy, respectively. The hypothesis of improving brain reorganization for stroke patients is confirmed by simultaneously applying both cognitive aspects and physical functions. Electrical stimulation and mirror therapy can be more effective during the period early after the stroke. It can be concluded that other factors such as intensity of stimulation, duration, and frequency of excitation or even the active stimulation can be resulted in the lack of confirmation of the efficacy of the active stimulation method versus the passive stimulation. The reliability of the results in the meta-analysis could be increased if more articles are used