ORIGINAL ARTICLE   Open access

European Journal of Physical and Rehabilitation Medicine 2024 April;60(2):280-91

DOI: 10.23736/S1973-9087.23.07625-6

Copyright © 2023 THE AUTHORS

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language: English

Mirror visual feedback as therapeutic modality in unilateral upper extremity complex regional pain syndrome type I: randomized controlled trial

Stanislav MACHAČ ¹ ✉, Ludmila CHASÁKOVÁ ¹, Soroush KAKAWAND ², Jiří KOZÁK ³, Lubomír ŠTĚPÁNEK ^{4, 5}, Jan VEJVALKA ⁶, Pavel KOLÁŘ ¹, Rudolf ČERNÝ ⁷

¹ Department of Rehabilitation and Sports Medicine, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic; ² Department of Neurology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA; ³ Department of Pain Research and Treatment, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic; ⁴ Institute of Biophysics and Informatics, First Faculty of Medicine, Charles University, Prague, Czech Republic; ⁵ Department of Statistics and Probability, Faculty of Informatics and Statistics, Prague University of Economics and Business, Prague, Czech Republic; ⁶ Department of Information Systems, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic; ⁷ Department of Neurology, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic

BACKGROUND: There is growing evidence for the effectiveness of mirror therapy (MT) on pain reduction in patients with type I complex regional pain syndrome (CRPS I).
AIM: To evaluate the efficacy of MT on pain reduction and hand function in subjects with unilateral upper extremity CRPS I.
DESIGN: Randomized controlled trial with control group cross-over (half cross-over design).
SETTING: Subjects with CRPS I were outpatients of a university hospital and cooperating centers. All patients carried out the daily exercise at home.
POPULATION: Subjects with unilateral upper extremity CRPS I meeting the Budapest diagnostic criteria.
METHODS: Subjects were randomly divided into two groups. Group A (N.=13) carried out a ten-minute MT exercise daily, for a total duration of six weeks. Group B (N.=14) acted as a control group for six weeks followed by six weeks of MT with the same characteristics as Group A. Upper extremity active range of motion, strength, dexterity, limb volume, affected-to-unaffected hand temperature difference, and health-related quality of life were evaluated before and after each period. Daily records on the visual analogue scale were used for pain evaluation. Effectiveness was calculated using mixed-effects modelling for between-group comparisons and within-group variability, and identification of significant predictors.
RESULTS: Twenty-three females and four males with an average age of 56.1±9.6 years completed the study. Except for the affected-to-unaffected hand temperature difference, both groups consistently demonstrated significant or near-significant improvements in measured parameters after MT period. The improvements were evident upon an intergroup comparison of Group A and the control period of Group B as well as longitudinally within Group B. No significant improvement was found during the control period.
CONCLUSIONS: Principles focused on mirror visual feedback to the central nervous system can sustain promising therapeutic potential as part of the treatment for pain reduction and hand function in CRPS I patients.
CLINICAL REHABILITATION IMPACT: MT can be considered as part of the therapeutic regimen employed for the treatment of CRPS I.

KEY WORDS: Complex regional pain syndromes; Mirror movement therapy; Feedback, sensory