Edinburgh Napier University

  Background And Aims: Mirror therapy provides a novel, cost-effective approach to upper limb treatment following stroke. However, the effectiveness of mirror therapy in sub-acute stroke is unclear. Qualitative studies enable exploration and optimisation of intervention acceptability and implementation. This study explored the experiences of individuals who received mirror therapy as part of their upper limb rehabilitation.

Methods: A qualitative approach was used to explore barriers and facilitators of mirror therapy. Three individuals who had used mirror therapy were recruited from one hospital and took part in a focus group led by an experienced moderator. The participants were FOUR-, 12- and 18-months post-stroke. The focus group was audio-recorded and transcribed verbatim. Thematic analysis was used to analyse the data.

Results: Three key themes were identified, namely: long-term recovery, healthcare barriers and practical considerations. Of note, participant experiences of mirror therapy were linked to their ongoing recovery, with physical and psychological factors impacting on intervention acceptability. Barriers to mirror therapy were posed by clinician decision-making with limited participant involvement. In addition, a lack of knowledge of mirror therapy was held in inpatient and community settings. Design aspects of the mirror box used impeded independent use by one participant with severe impairment. Further analysis of the themes posited a systems-based framework to improve mirror therapy delivery and to support sustainable independent practice, based on education, collaborative goal-setting and co-production.

Conclusions: Mirror therapy is an acceptable upper limb treatment. A person-centred approach across healthcare settings is recommended to improve implementation and to facilitate self-management practices from hospital to home.