Mirror therapy combined with neuromuscular electrical stimulation for poststroke lower extremity motor function recovery: a systematic review and meta-analysis

The combination of mirror therapy (MT) and neuromuscular electrical stimulation (NMES) has been devised as an intervention method in stroke rehabilitation; however, few studies have investigated its efficacy in lower extremity motor function recovery. In this systematic review and meta-analysis, we examined the effectiveness of combined MT and NMES therapy in improving poststroke walking speed, spasticity, balance and other gait parameters. Randomized controlled trials (RCTs) were selected from PubMed, Cochrane Library, EMBASE, and Scopus databases. In total, six RCTs which involving 181 participants were included. Our findings indicate that MT combined with NMES elicits greater improvement relative to control group in walking speed (SMD = 0.67, 95% confidence interval [CI] 0.26–1.07, P = 0.001), Berg Balance Scale (SMD = 0.72; 95% CI 0.31–1.13; P = 0.0007), cadence (SMD = 0.59, 95% CI 0.02–1.16, P = 0.04), step length (SMD = 0.94, 95% CI 0.35–1.53, P = 0.002), and stride length (SMD = 0.95, 95% CI 0.36–1.54, P = 0.002) but not in modified Ashworth scale (SMD = − 0.40, 95% CI − 1.05 to 0.26, P = 0.23). Our findings suggest that MT combined with NMES may be a suitable supplemental intervention to conventional therapy in stroke survivors.