Comparative effectiveness of mirror therapy using different delivery media on motor recovery of the upper limb and hand in stroke patients: A systematic review and network meta-analysis
Bin Shi, Guangxue Zhou, Ning XuObjective
This study aimed to compare the effects of mirror therapy delivered through different media on upper limb and hand motor recovery in stroke patients using a network meta-analysis.
Data sources
Five electronic databases were searched from inception to 7 September 2026.
Review methods
Methodological quality was assessed using the Cochrane risk-of-bias tool (RoB 2.0). A Bayesian framework was applied for network meta-analysis, and evidence quality was evaluated using the Grading of Recommendations Assessment, Development and Evaluation.
Results
Thirty trials involving 1212 participants were included, covering three mirror therapy modalities. Network meta-analysis showed that, compared with control group, virtual reality-based mirror therapy (mean difference [MD] = 8.75; 95% credible interval [CrI]: 4.56 to 13.30), digital screen-based mirror therapy (MD = 6.95; 95% CrI: 3.18 to 10.48), and traditional mirror therapy (MD = 5.29; 95% CrI: 2.58 to 7.70) significantly improved upper limb motor function. For hand motor function, virtual reality-based mirror therapy was superior to the control group (MD = 4.65; 95% CrI: 1.06 to 8.16) and traditional mirror therapy (MD = 3.77; 95% CrI: 0.54 to 7.14). Virtual reality-based mirror therapy consistently ranked as the most effective intervention. The certainty of evidence ranged from very low to moderate.
Conclusion
Virtual reality-based mirror therapy showed the most favourable exploratory effect estimates, but the relative efficacy of different delivery media remains uncertain because most comparisons were indirect and the certainty of evidence for hand motor function was very low. Head-to-head trials are needed to confirm these findings.