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Mirror Therapy in Complex Regional Pain Syndrome Type 1 of the Upper Limb in Stroke Patients

Department of Physical Medicine and Rehabilitation, "San Salvatore" Hospital of L'Aquila, L'Aquila, Italy,angelo.cacchio{at}tin.it

Elisabetta De Blasis, MD

Department of Emergency, Intensive Cardiology Division, "SS Filippo e Nicola" Hospital of Avezzano, L'Aquila, Italy

Vincenzo De Blasis, MSc

International Activities Service, Abruzzo Region Offices, L'Aquila, Italy

Valter Santilli, MD

Department of Physical Medicine and Rehabilitation, University of Roma "La Sapienza", Roma, Italy

Giorgio Spacca, MD

Department of Physical Medicine and Rehabilitation, "San Salvatore" Hospital of L'Aquila, L'Aquila, Italy

Background. Complex regional pain syndrome type 1 (CRPSt1) of the upper limb is a painful and debilitating condition, frequent after stroke, and interferes with the rehabilitative process and outcome. However, treatments used for CRPSt1 of the upper limb are limited. Objective. This randomized controlled study was conducted to compare the effectiveness on pain and upper limb function of mirror therapy on CRPSt1 of upper limb in patients with acute stroke. Methods. Of 208 patients with first episode of unilateral stroke admitted to the authors’ rehabilitation center, 48 patients with CRPSt1 of the affected upper limb were enrolled in a randomized controlled study, with a 6-month follow-up, and assigned to either a mirror therapy group or placebo control group. The primary end points were a reduction in the visual analogue scale score of pain at rest, on movement, and brush-induced tactile allodynia. The secondary end points were improvement in motor function as assessed by the Wolf Motor Function Test and Motor Activity Log. Results. The mean scores of both the primary and secondary end points significantly improved in the mirror group (P < .001). No statistically significant improvement was observed in any of the control group values (P > .001). Moreover, statistically significant differences after treatment (P < .001) and at the 6-month follow-up were found between the 2 groups. Conclusions. The results indicate that mirror therapy effectively reduces pain and enhances upper limb motor function in stroke patients with upper limb CRPSt1.

Key Words: Stroke • Complex regional pain syndrome • Mirror therapy • Poststroke shoulder pain • Pain • Rehabilitation

This version was published on October 1, 2009

Neurorehabilitation and Neural Repair, Vol. 23, No. 8, 792-799 (2009)
DOI: 10.1177/1545968309335977


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