Implementing Mirror Therapy and Mental Imagery for Stroke Inpatient Rehabilitation: Adoption, Acceptability, and Feasibility
Jessica Schmidt, Elizabeth Khoury, Gretl Sherburne, Lauren Dittburner, Miriam R. Rafferty, Jessica EdelsteinImportance
Mirror therapy and mental imagery (MTMI) are evidence-based interventions for upper extremity motor recovery after stroke, yet they remain underused in clinical practice. Implementation science offers a systematic approach in improving uptake in real-world settings.
Objective
To evaluate the changes in clinician acceptability, feasibility, adoption, and patient reach of MTMI over 12 months.
Design
Prospective, single-site implementation evaluation guided by implementation science frameworks.
Setting
A free-standing inpatient rehabilitation hospital.
Participants
Occupational therapists (
Intervention
A therapist-led, 60 min MTMI group was delivered two to three times weekly. Six implementation barriers were identified. Implementation strategies: clinician education, training, support, and infrastructure changes.
Outcomes and Measures
Therapist acceptability and feasibility were measured using the Acceptability of Intervention Measure (AIM) and Feasibility of Intervention Measure (FIM) at baseline, 4 months, and 12 months. Therapist adoption was assessed through training records and self-report. Patient reach was derived from attendance-tracking and hospital-admission data.
Results
AIM and FIM scores remained high across all time points (AIM 4.4–4.8; FIM 4.6–4.8). Adoption increased over time: therapists trained to lead MTMI rose from 11% to 61%, and self-reported MTMI use increased from 63% to 92%. The mean monthly patient reach was 39%.
Conclusions and Relevance
Multimodal implementation strategies supported high acceptability, feasibility, and clinician adoption of MTMI in inpatient rehabilitation. Patient reach remained modest.
What This Article Adds
This study provides practical, context-specific guidance for integrating MTMI into inpatient rehabilitation.