Mirror Therapy Versus Action Observation Therapy on Upper Limb Motor Function, Functional Independence, and Quality Oflife Among Chronic Stroke Patients

NCT07641803 | Completed DMC

• 1 other identifier: UOL/IREB/25/09/0032
• Study Type: interventional
• Target: 76
• Locations: 1 country
• Sites: 1

Brief Summary

This randomized controlled trial aims to compare the effects of Mirror Therapy (MT) and Action Observation Therapy (AOT) on upper limb motor function, functional independence, and health-related quality of life in individuals with chronic stroke. Stroke-related upper limb impairment remains a major cause of long-term disability and reduced independence. Both MT and AOT are neurocognitive rehabilitation approaches based on activation of the mirror neuron system and promotion of neuroplasticity. Eligible participants with chronic stroke will be randomly allocated to either a Mirror Therapy group or an Action Observation Therapy group and will receive supervised interventions in addition to standard physiotherapy. Outcomes will be assessed using the Motor Evaluation Scale for Upper Extremity in Stroke Patients (MESUPES), Fugl-Meyer Assessment for Upper Extremity (FMA-UE), and Short Form-36 Health Survey (SF-36). The study seeks to determine the comparative effectiveness of these interventions for improving upper limb function, functional independence, and quality of life among chronic stroke survivors.

Conditions

Stroke

Keywords

Action Observation; Chronic Stroke; Mirror Therapy; Motor Recovery; Quality of Life

Outcome Measures

Primary Outcomes (2)

• Upper Limb Motor Function

  Upper limb motor function will be assessed using the Motor Evaluation Scale for Upper Extremity in Stroke Patients (MESUPES). Higher scores indicate better upper extremity motor performance and functional ability.

  Baseline and 6 weeks (end of intervention)

• Upper Extremity Motor Recovery

  Motor recovery will be evaluated using the Fugl-Meyer Assessment for Upper Extremity (FMA-UE). The scale assesses motor impairment, coordination, reflex activity, and voluntary movement, with higher scores indicating improved motor recovery.

  Baseline and 6 weeks (end of intervention)

Secondary Outcomes (1)

• Health-Related Quality of Life

  Baseline and 6 weeks (end of intervention)

Study Arms (2)

Mirror Therapy Group

EXPERIMENTAL

Participants assigned to this group will receive Mirror Therapy in addition to standard physiotherapy. A mirror will be positioned in the midline so that movements of the unaffected upper limb are reflected, creating the visual illusion that the affected limb is moving normally. Treatment sessions will last 45 minutes, five days per week for six weeks. The intervention will include simple joint movements, functional upper limb activities, and task-specific training designed to promote motor recovery, functional independence, and neuroplasticity.

Behavioral: Mirror Therapy

Action Observation Therapy Group

EXPERIMENTAL

Participants assigned to this group will receive Action Observation Therapy in addition to standard physiotherapy. Participants will observe videos demonstrating goal-directed upper limb activities and subsequently imitate the observed movements under physiotherapist supervision. Treatment sessions will last 45 minutes, five days per week for six weeks. The intervention will include observation, guided imitation, and repetitive practice of functional tasks aimed at improving motor planning, motor execution, upper limb function, and functional independence.

Behavioral: Action Observation Therapy

Interventions

Mirror Therapy BEHAVIORAL

Participants assigned to the Mirror Therapy intervention will receive supervised upper limb rehabilitation using mirror-induced visual feedback. A mirror will be positioned in the participant's midline, allowing observation of the reflection of the unaffected upper limb while the affected limb remains hidden. Sessions will include simple joint movements, functional tasks, and task-specific activities designed to promote motor relearning and cortical reorganization. Treatment will be delivered for 45 minutes per session, five days per week, for six weeks, alongside standard physiotherapy.

Mirror Therapy Group

Action Observation Therapy BEHAVIORAL

Participants assigned to the Action Observation Therapy intervention will observe videos demonstrating goal-directed upper limb activities and subsequently practice the observed movements under physiotherapist supervision. The intervention consists of an observation phase, guided imitation, and repetitive task practice to facilitate motor learning and neuroplasticity. Treatment sessions will last 45 minutes and will be conducted five days per week for six weeks in addition to standard physiotherapy.

Action Observation Therapy Group

Eligibility Criteria

• Age: 45 Years - 75 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Individuals diagnosed with chronic stroke (≥6 months post-stroke).
• Patients with stroke affecting either the left or right upper limb will be included.
• Mild-to-moderate upper limb motor impairment (Fugl-Meyer Upper Extremity Score between 19-55).
• Ability to follow verbal and visual instructions.
• Medically stable with no active comorbidities affecting rehabilitation (Tang et al., 2024).

You may not qualify if:

• Severe cognitive or communication impairments prevent task understanding.
• Presence of severe upper limb spasticity or contractures.
• History of severe visual or perceptual deficits (e.g., neglect, hemianopia).
• Uncontrolled epilepsy or active psychiatric disorders.
• Participation in other upper limb rehabilitation programs during the study period.

Sponsors & Collaborators

• University of Lahore: lead

Study Sites (1)

The University of Lahore Teaching Hospital

Lahore, 54590, Pakistan

Location

Related Publications (4)

• Binks JA, Emerson JR, Scott MW, Wilson C, van Schaik P, Eaves DL. Enhancing upper-limb neurorehabilitation in chronic stroke survivors using combined action observation and motor imagery therapy. Front Neurol. 2023 Mar 2;14:1097422. doi: 10.3389/fneur.2023.1097422. eCollection 2023.

  PMID: 36937513 BACKGROUND

• Effectiveness of Home-Based Mirror Therapy on Enhancing the Upper Limb Sensory- Motor Recovery of Elderly Patients Post-Stroke. Assiut Scientific Nursing Journal, 12(41), 137-149.

  BACKGROUND

• Kim YS, Song JY, Park SH, Lee MM. Effect of functional electrical stimulation-based mirror therapy using gesture recognition biofeedback on upper extremity function in patients with chronic stroke: A randomized controlled trial. Medicine (Baltimore). 2023 Dec 29;102(52):e36546. doi: 10.1097/MD.0000000000036546.

  PMID: 38206692 BACKGROUND

• Tang E, Moran N, Cadman M, Hill S, Sloan C, Warburton E; guideline committee. Stroke rehabilitation in adults: summary of updated NICE guidance. BMJ. 2024 Mar 22;384:q498. doi: 10.1136/bmj.q498. No abstract available.

  PMID: 38519084 BACKGROUND

MeSH Terms

Conditions

Stroke

Interventions

Mirror Movement Therapy

Condition Hierarchy (Ancestors)

Cerebrovascular Disorders; Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Vascular Diseases; Cardiovascular Diseases

Intervention Hierarchy (Ancestors)

Physical Therapy Modalities; Rehabilitation; Therapeutics

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: OUTCOMES ASSESSOR
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: June 6, 2026
• First Posted: June 11, 2026
• Study Start: February 3, 2025
• Primary Completion: March 19, 2026
• Study Completion: April 28, 2026
• Last Updated: June 11, 2026

Record last verified: 2026-06

Data Sharing

• IPD Sharing: Will not share

Locations

PA (1)