Mapping the current evidence on mirror therapy, soft robotic gloves, and their combined use in upper limb rehabilitation after stroke: a scoping review

Abstract

Upper-limb impairment after stroke can restrict hand use, activities of daily living, and functional independence. Mirror therapy (MT) and soft robotic glove (SRG)-based rehabilitation represent technology-enabled approaches to upper-limb rehabilitation. The extent and characteristics of evidence examining these approaches individually and in combination have not been mapped. To map the literature on MT, SRG-based rehabilitation, and their combined use after stroke, with emphasis on study characteristics, intervention dosage, outcome measures, technological integration, safety reporting, and evidence gaps. This scoping review followed Joanna Briggs Institute (JBI) methodology and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR). PubMed/MEDLINE, Scopus, and CENTRAL were searched in the original review. The Scopus strategy was rerun using OR between the MT and SRG concept blocks, and IEEE Xplore was searched to improve engineering-literature coverage. Eligible interventional studies involved adults with stroke receiving MT, SRG-based rehabilitation, a direct MT + SRG combination, or a direct MT-versus-SRG comparison. Data were charted using a standardized form and synthesized descriptively; study-level fields were rechecked against accessible full-text articles or primary records to resolve classification and reporting discrepancies. The evidence map included 84 studies reporting 2,634 stroke participants. Fifty-four studies were MT-only (64.3%), 27 were SRG-only (32.1%), two directly combined MT + SRG (2.4%), and one directly compared MT with SRG (1.2%). Randomized controlled/clinical trials accounted for 53 studies (63.1%) and pilot/feasibility studies for 16 (19.0%). Chronic stroke was explicitly represented in 31 studies (36.9%), subacute stroke in 15 (17.9%), acute stroke in five (6.0%), and mixed acute/subacute populations in two (2.4%); stage was unspecified/other in 31 (36.9%). FMA was charted in 35 studies (41.7%), ARAT in 12 (14.3%), and ADL/independence outcomes in 19 (22.6%). Safety was not reported in 52 studies (61.9%); 23 (27.4%) explicitly reported no serious/adverse safety signal. The evidence base is substantially larger for MT or SRG studied separately than for their direct combination. Considerable heterogeneity exists in study design, stroke stage, intervention dosage, outcome selection, technology integration, and safety reporting. The review provides an evidence map and identifies areas requiring further investigation without making claims of comparative treatment superiority.