Outcomes of Mirror Therapy Preceding Augmented Reality in Stroke Rehabilitation: A Randomized Controlled Trial

Abstract

Importance Although augmented reality (AR) may improve functional outcomes after stroke, the added benefit of mirror therapy (MT) as a priming strategy before AR remains uncertain. A three-arm comparison of MT + AR, AR alone, and conventional therapy (CT) is needed to clarify whether MT priming provides additional benefit. Objective To examine whether AR, with or without MT priming, improves sensorimotor function, balance, quality of life, and self-efficacy after stroke. Design Single-blind randomized controlled trial with 3-month follow-up. Setting Five outpatient rehabilitation clinics. Participants Seventy-seven individuals with first-ever stroke were randomized to MT + AR (n = 26), AR (n = 26), or CT (n = 25). Intervention Participants received 90-min sessions, 3 times/week for 6 weeks. Outcome Measures Primary outcomes were the Fugl–Meyer Assessment–Upper Extremity (FMA-UE) and Berg Balance Scale. Secondary outcomes included sensory function, arm activity/use, self-efficacy, and quality of life. Clinical significance was determined using the minimal clinically important difference (MCID). Results The MT + AR group showed greater improvements in motor and sensory outcomes than AR and CT, with the highest portion of participants exceeding MCID among the three groups. Both MT + AR and AR demonstrated superior gains in balance, arm use, self-efficacy, and quality of life compared with CT, with a higher percentage exceeding MCID. Improvements were maintained at follow-up. Conclusions and Relevance MT priming enhances AR effects on motor and sensory recovery. AR yields clinically meaningful improvements in function, participation, and quality of life after stroke. Plain-Language Summary This study explored whether combining MT with augmented reality (AR) could improve recovery after stroke. Seventy-seven people with stroke participated in a 6-week rehabilitation program and were assigned to one of three groups: MT followed by AR, AR alone, or conventional therapy. The study found that people who received both MT and AR showed the greatest improvements in arm movement and sensation. Those who received AR (with or without MT) also improved in balance, daily use of the affected arm, confidence in performing activities, and quality of life compared with conventional therapy. Importantly, many participants achieved meaningful improvements that could make a real difference in daily life, and these benefits lasted for at least 3 months. These findings suggest that AR is an effective rehabilitation tool after stroke, and adding MT may further enhance recovery of movement and sensation.