Effect of mirror therapy combined with transcranial direct current stimulation on upper limb motor function in stroke patients: A meta-analysis
TL;DR
MT combined with tDCS appears to provide additional benefits for poststroke upper limb motor recovery, with consistent improvements in Fugl-Meyer Assessment for Upper Extremity and favorable effects on daily functioning and hand performance in key comparisons, however, heterogeneity across protocols and imprecision in some outcomes limit certainty.
Abstract
Background: Upper limb motor impairment is a major contributor to long-term disability after stroke. Mirror therapy (MT) promotes motor relearning through visuomotor feedback, whereas transcranial direct current stimulation (tDCS) may facilitate neuroplasticity by modulating cortical excitability. We conducted a systematic review and meta-analysis to evaluate whether MT combined with tDCS provides additional benefits for poststroke upper limb rehabilitation. Methods: We searched PubMed, Embase, Web of Science, the Cochrane Library, CNKI, and Wanfang for randomized controlled trials (RCTs) published from 2015 to November 2025. Eligible studies enrolled adults with stroke-related upper limb motor deficits and compared MT + tDCS with MT alone or tDCS alone. Results: Twelve RCTs involving 1024 participants were included. For Fugl-Meyer Assessment for Upper Extremity, MT + tDCS showed superior improvement versus MT alone (3 studies; I-squared statistic (I2) = 21.9%; MD = 12.65, 95% confidence interval [CI] 10.07–15.23) and versus tDCS alone (7 studies; I2 = 93.3%; MD = 7.03, 95% CI 3.76–10.31). For activities of daily living, the effect on Modified Barthel Index versus MT alone was highly heterogeneous and imprecise (2 studies; I2 = 94.7%; MD = 24.19, 95% CI − 144.99 to 193.38), whereas MT + tDCS significantly improved Modified Barthel Index versus tDCS alone (5 studies; I2 = 42.7%; MD = 9.29, 95% CI 6.36–12.22). For hand function, MT + tDCS improved Wolf Motor Function Test versus tDCS alone (3 studies; I2 = 80.3%; MD = 4.90, 95% CI 0.59–9.22). Reported adverse events were generally mild and transient. Conclusion: MT combined with tDCS appears to provide additional benefits for poststroke upper limb motor recovery, with consistent improvements in Fugl-Meyer Assessment for Upper Extremity and favorable effects on daily functioning and hand performance in key comparisons. However, heterogeneity across protocols and imprecision in some outcomes limit certainty. Larger, rigorously designed RCTs with standardized MT dosing and tDCS parameters and longer follow-up are warranted.