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The goal of this clinical study is to evaluate the effectiveness of mirror therapy in treating complex regional pain syndrome (CRPS) in patients after stroke using clinical assessments, electrophysiological evaluations, and ultrasonographic measurements by comparing pre- and post-treatment outcomes.
The main questions it aims to answer are:
Does mirror therapy lead to improvements in clinical outcomes in post-stroke patients with CRPS when assessed before and after treatment? Does mirror therapy reduce pain, improve motor function, and enhance functional independence based on clinical assessments? Does mirror therapy reduce swelling (edema) in the affected limb as measured by ultrasonographic evaluations? Does mirror therapy lead to changes in sympathetic nervous system function as assessed by electrophysiological evaluations?
Researchers will compare mirror therapy to sham mirror therapy (a similar procedure without therapeutic effect) to determine its effectiveness.
Participants will:
Be randomly assigned to either a mirror therapy group or a control group Receive conventional rehabilitation therapy and contrast bath treatment for 4 weeks Receive either mirror therapy or sham mirror therapy for 20 minutes daily Be evaluated before and after treatment using clinical scales, electrophysiological tests, and ultrasonographic measurements.
Complex regional pain syndrome (CRPS) is a challenging complication following stroke, characterized by pain, edema, autonomic dysfunction, and impaired motor function. It significantly affects rehabilitation outcomes and quality of life. Despite various treatment approaches, optimal management remains difficult. Mirror therapy has emerged as a non-invasive rehabilitation technique that provides visual feedback and may influence cortical reorganization and pain modulation. Additionally, it may have effects on autonomic function, particularly the sympathetic nervous system.
This prospective, randomized, single-blind study was conducted in the inpatient Physical Medicine and Rehabilitation clinic of Başakşehir Çam and Sakura City Hospital between October 2022 and October 2023. Patients with post-stroke CRPS who met the inclusion criteria were enrolled and randomly assigned to either a mirror therapy group or a control group. Both groups received a standardized conventional rehabilitation program and contrast bath therapy. The intervention group additionally received mirror therapy, while the control group received sham mirror therapy.
The aim of the study was to evaluate the clinical effectiveness of mirror therapy in post-stroke CRPS through a multidimensional approach. Clinical status, functional outcomes, electrophysiological parameters related to sympathetic nervous system function, and ultrasonographic measurements of soft tissue changes were assessed before and after the intervention period.
This study provides comprehensive evaluation of mirror therapy effects by combining clinical assessments with objective electrophysiological and imaging-based measurements. The findings are expected to contribute to the understanding of the role of mirror therapy in the management of CRPS after stroke and to support its use as an accessible and complementary rehabilitation approach.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Mirror Therapy Group | Experimental | Participants in this arm received conventional rehabilitation therapy and contrast bath therapy for 4 weeks in addition to mirror therapy for 20 minutes daily |
|
| Sham Mirror Therapy Group | Sham Comparator | Participants in this arm received conventional rehabilitation therapy and contrast bath therapy for 4 weeks in addition to sham mirror therapy for 20 minutes daily |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Mirror Therapy | Behavioral | Mirror therapy was applied for 20 minutes daily for 4 weeks in addition to a conventional rehabilitation program and contrast bath therapy. Patients performed movements of the unaffected upper limb while watching its reflection in a mirror positioned in the mid-sagittal plane, creating the illusion of movement in the affected limb. |
| Measure | Description | Time Frame |
|---|---|---|
| Change in pain intensity (Visual Analog Scale - VAS) | Pain intensity will be assessed using the Visual Analog Scale (VAS) before and after the 4-week treatment period. | Baseline and after 4 weeks |
| Measure | Description | Time Frame |
|---|---|---|
| Change in motor recovery (Brunnstrom Staging) | Motor recovery will be assessed using Brunnstrom Staging before and after treatment. | Baseline and after 4 weeks |
| Change in upper extremity motor function (Fugl-Meyer Assessment) |
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Inclusion Criteria:
Exclusion Criteria:
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Başakşehir Çam&Sakura City Hospital | Istanbul | Turkey (Türkiye) |
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| ID | Term |
|---|---|
| D020521 | Stroke |
| D020918 | Complex Regional Pain Syndromes |
| ID | Term |
|---|---|
| D002561 | Cerebrovascular Disorders |
| D001927 | Brain Diseases |
| D002493 | Central Nervous System Diseases |
| D009422 | Nervous System Diseases |
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| ID | Term |
|---|---|
| D000088762 | Mirror Movement Therapy |
| ID | Term |
|---|---|
| D026741 | Physical Therapy Modalities |
| D012046 | Rehabilitation |
| D013812 | Therapeutics |
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| Sham Mirror Therapy | Behavioral | Sham mirror therapy was applied for 20 minutes daily for 4 weeks in addition to a conventional rehabilitation program and contrast bath therapy. The non-reflective side of the mirror was used so that no visual feedback of the affected limb was provided, and patients performed similar movements without the mirror illusion. |
|
Upper extremity motor function will be evaluated using the Fugl-Meyer Assessment before and after treatment.
| Baseline and after 4 weeks |
| Change in spasticity (Modified Ashworth Scale, MAS) | Spasticity will be assessed using the Modified Ashworth Scale before and after treatment. | Baseline and after 4 weeks |
| Change in functional independence (Functional Independence Measure, FIM) | Functional independence will be assessed using the Functional Independence Measure before and after treatment. | Baseline and after 4 weeks |
| Change in neuropathic pain (DN4) | Neuropathic pain will be evaluated using the DN4 questionnaire before and after treatment. | Baseline and after 4 weeks |
| Change in neuropathic pain (LANSS) | Neuropathic pain will be evaluated using the LANSS scale before and after treatment. | Baseline and after 4 weeks |
| Change in sympathetic nervous system function (sympathetic skin response) | Sympathetic nervous system function will be evaluated using sympathetic skin response measurements before and after treatment. | Baseline and after 4 weeks |
| Change in cutaneous silent period (CSP) | Cutaneous silent period will be measured to evaluate electrophysiological changes before and after treatment. | Baseline and after 4 weeks |
| Change in subcutaneous tissue thickness (ultrasonography) | Subcutaneous tissue thickness will be measured using ultrasonography before and after treatment. | Baseline and after 4 weeks |
| D014652 | Vascular Diseases |
| D002318 | Cardiovascular Diseases |
| D001342 | Autonomic Nervous System Diseases |
| D010523 | Peripheral Nervous System Diseases |
| D009468 | Neuromuscular Diseases |