title: The effects of mirror therapy on pain and motor control of phantom limb in amputees: A systematic review.
abstract: OBJECTIVE
  Phantom limb pain (PLP) is a major problem after limb amputation. Mirror therapy (MT) is a non-pharmacological treatment using representations of movement, the efficacy of which in reducing PLP remains to be clarified. Here, we present the first systematic review on MT efficacy in PLP and phantom limb movement (PLM) in amputees (lower or upper limb).
  
  
  METHODS
  A search on Medline, Cochrane Database and Embase, crossing the keywords "Phantom Limb" and "Mirror Therapy" found studies which were read and analyzed according the PRISMA statement.
  
  
  RESULTS
  Twenty studies were selected, 12 on the subject of MT and PLP, 3 on MT and PLM, 5 on MT and both (PLP and PLM). Among these 20 studies, 5 were randomized controlled trials (163 patients), 6 prospective studies (55 patients), 9 case studies (40 patients) and methodologies were heterogeneous. Seventeen of the 18 studies reported the efficacy of MT on PLP, but with low levels of evidence. One randomized controlled trial did not show any significant effect of MT. As to the effect of MT on PLM, the 8 studies concerned reported effectiveness of MT: 4 with a low level of evidence and 4 with a high level of evidence. An alternative to visual illusion seems to be tactile or auditory stimulation.
  
  
  CONCLUSIONS
  We cannot recommend MT as a first intention treatment in PLP. The level of evidence is insufficient. Further research is needed to assess the effect of MT on pain, prosthesis use, and body representation, and to standardize protocols.
authors.affiliation: Département de MPR, Institut de rééducation-Hôpital sud, CHU des Alpes, avenue de Kimberley, 38130 Echirolles, France; Service de MPR, centre hospitalier Tullins, 18, boulevard Michel-Perret, 38210 Tullins, France. Electronic address: b.jessie@hotmail.fr.
authors.forename: J
authors.initials: J
authors.lastname: Barbin
authors.affiliation: Département de MPR, Institut de rééducation-Hôpital sud, CHU des Alpes, avenue de Kimberley, 38130 Echirolles, France.
authors.forename: V
authors.initials: V
authors.lastname: Seetha
authors.affiliation: Service de rééducation, Centre Hospitalier Universitaire Dijon, 14, rue Gaffarel, 21079 Dijon, France.
authors.forename: J M
authors.initials: JM
authors.lastname: Casillas
authors.affiliation: Institut régional de médecine physique et de réadaptation, 75, boulevard Lobau, 54042 Nancy, France.
authors.forename: J
authors.initials: J
authors.lastname: Paysant
authors.affiliation: Département de MPR, Institut de rééducation-Hôpital sud, CHU des Alpes, avenue de Kimberley, 38130 Echirolles, France; Laboratoire LPNC, Université Grenoble Alpes, France.
authors.forename: D
authors.initials: D
authors.lastname: Pérennou
mesh_terms: D000328:Adult; D000674:Amputees / Q000523:psychology / Q000534:rehabilitation*; D005260:Female; D006801:Humans; D019018:Imagery, Psychotherapy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D059408:Pain Management / Q000379:methods* / Q000523:psychology; D010591:Phantom Limb / Q000503:physiopathology / Q000523:psychology / Q000534:rehabilitation*; D026741:Physical Therapy Modalities; D011597:Psychomotor Performance
keywords: Amputee; Mirror therapy; Phantom Limb