title: Phase II Pragmatic Randomized Controlled Trial of Patient-Led Therapies (Mirror Therapy and Lower-Limb Exercises) During Inpatient Stroke Rehabilitation.
abstract: OBJECTIVE
  Patient-led therapy has the potential to increase the amount of therapy patients undertake during stroke rehabilitation and to enhance recovery. Our objective was to assess the feasibility and acceptability of 2 patient-led therapies during the acute stages of stroke care: mirror therapy for the upper limb and lower-limb exercises for the lower limb.
  
  
  METHODS
  This was a blind assessed, multicenter, pragmatic randomized controlled trial of patient-led upper-limb mirror therapy and patient-led lower leg exercises. Stroke survivors with upper and lower limb limitations, undergoing inpatient rehabilitation and able to consent were recruited at least 1 week poststroke.
  
  
  RESULTS
  Both interventions proved feasible, with >90% retention. No serious adverse events were reported. Both groups did less therapy than recommended; typically 5 to 15 minutes for 7 days or less. Participants receiving mirror therapy (n = 63) tended to do less practice than those doing lower-limb exercises (n = 31). Those with neglect did 69% less mirror therapy than those without (P = .02), which was not observed in the exercise group. Observed between-group differences were modest but neglect, upper-limb strength, and dexterity showed some improvement in the mirror therapy group. No changes were seen in the lower-limb group.
  
  
  CONCLUSIONS
  Both patient-led mirror therapy and lower-limb exercises during inpatient stroke care are safe, feasible, and acceptable and warrant further investigation. Practice for 5 to 15 minutes for 7 days is a realistic prescription unless strategies to enhance adherence are included.
authors.affiliation: University of Manchester, Manchester, UK School of Nursing Midwifery & Social Word, Manchester, UK Sarah.tyson@manchester.ac.uk.
authors.forename: Sarah
authors.initials: S
authors.lastname: Tyson
authors.affiliation: University of Manchester, Manchester, UK Salford Royal NHS Foundation Trust, UK.
authors.forename: Jack
authors.initials: J
authors.lastname: Wilkinson
authors.affiliation: University of Manchester, Manchester, UK School of Nursing Midwifery & Social Word, Manchester, UK.
authors.forename: Nessa
authors.initials: N
authors.lastname: Thomas
authors.affiliation: Erasmus MC, Rotterdam, the Netherlands.
authors.forename: Ruud
authors.initials: R
authors.lastname: Selles
authors.affiliation: University of the West England, Bristol and Royal National Hospital for Rheumatic Diseases NHS Foundation Trust, Bath, UK.
authors.forename: Candy
authors.initials: C
authors.lastname: McCabe
authors.affiliation: University of Manchester, Manchester, UK Salford Royal NHS Foundation Trust, UK.
authors.forename: Pippa
authors.initials: P
authors.lastname: Tyrrell
authors.affiliation: University of Manchester, Manchester, UK Salford Royal NHS Foundation Trust, UK.
authors.forename: Andy
authors.initials: A
authors.lastname: Vail
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005081:Exercise Therapy; D005260:Female; D006801:Humans; D007297:Inpatients; D035002:Lower Extremity / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D026741:Physical Therapy Modalities; D011597:Psychomotor Performance; D020127:Recovery of Function; D020521:Stroke / Q000503:physiopathology; D000071939:Stroke Rehabilitation; D016896:Treatment Outcome; D034941:Upper Extremity / Q000503:physiopathology
keywords: exercise; mirror therapy; patient-led; stroke