Comparative Effects of Mirror Therapy, Proprioceptive Neuromuscular Facilitation, and Constraint-Induced Movement Therapy on Upper Limb Motor Recovery in Stroke Survivors: A Three-Arm Randomized Controlled Trial
Optimizing Upper Limb Motor Function, Dexterity, and Functional Independence After Stroke
Keywords:
Constraint-Induced Movement Therapy, Mirror Therapy, Motor Recovery, Randomized Controlled Trial, Stroke Rehabilitation, Proprioceptive Neuromuscular FacilitationAbstract
Background: The majority of stroke survivors have upper-limb weakness, which reduces their functional independence in the real
world, but there is limited evidence from trials that directly compare upper-limb rehabilitation interventions. The study compared
the efficacy of three types of therapies (Mirror Therapy (MT), Proprioceptive Neuromuscular Facilitation (PNF), and Constraint
Induced Movement Therapy (CIMT)) in restoring motor function of the affected upper limb after stroke, when combined with
conventional physiotherapy.
Methods: This was a three-arm parallel-group trial of 90 adults with post-stroke upper-limb hemiparesis, with blinded outcome
assessment. The participants were allocated in a 1:1:1 ratio to MT, PNF, or CIMT, each with conventional physiotherapy, 6 days
per week. The Action Research Arm Test (ARAT), Fugl-Meyer Assessment of the Upper Extremity (FMA-UE), Modified Ashworth
Scale (MAS), and grip strength were measured by a blinded assessor at baseline and at 12 weeks.
Results: All 90 participants completed the trial with significant improvements from baseline on all four measures (p<0.001). A
between-group difference at week 12 emerged only for the ARAT (one-way ANOVA, F=9.335, p<0.001): CIMT scored higher than
both MT (p=0.002) and PNF (p<0.001), whereas MT and PNF were statistically indistinguishable. FMA-UE, MAS, and grip strength
showed no between-group differences.
Conclusion: All three interventions improved upper-limb function with CIMT showing the greatest benefit in task performance, as
measured by the ARAT. When CIMT is not feasible, MT and PNF are effective alternatives. This highlights the need to tailor
therapy choices to each patient’s goals and resources.
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Copyright (c) 2026 Subhan Ali Gondal, Aliha Shafqat , Namara Atif, Saleha Khan, Aqsa Noreen, Dr. Nusrat Naseem
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