Mirror therapy is used to improve motor function after stroke. During mirror therapy, a mirror is placed in the person's midsagittal plane, thus reflecting movements of the non-paretic side as if it ...were the affected side.
To summarise the effectiveness of mirror therapy compared with no treatment, placebo or sham therapy, or other treatments for improving motor function and motor impairment after stroke. We also aimed to assess the effects of mirror therapy on activities of daily living, pain, and visuospatial neglect.
We searched the Cochrane Stroke Group's Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, CINAHL, AMED, PsycINFO and PEDro (last searched 16 August 2017). We also handsearched relevant conference proceedings, trials and research registers, checked reference lists, and contacted trialists, researchers and experts in our field of study.
We included randomised controlled trials (RCTs) and randomised cross-over trials comparing mirror therapy with any control intervention for people after stroke.
Two review authors independently selected trials based on the inclusion criteria, documented the methodological quality, assessed risks of bias in the included studies, and extracted data. We assessed the quality of the evidence using the GRADE approach. We analysed the results as standardised mean differences (SMDs) or mean differences (MDs) for continuous variables, and as odds ratios (ORs) for dichotomous variables.
We included 62 studies with a total of 1982 participants that compared mirror therapy with other interventions. Of these, 57 were randomised controlled trials and five randomised cross-over trials. Participants had a mean age of 59 years (30 to 73 years). Mirror therapy was provided three to seven times a week, between 15 and 60 minutes for each session for two to eight weeks (on average five times a week, 30 minutes a session for four weeks).When compared with all other interventions, we found moderate-quality evidence that mirror therapy has a significant positive effect on motor function (SMD 0.47, 95% CI 0.27 to 0.67; 1173 participants; 36 studies) and motor impairment (SMD 0.49, 95% CI 0.32 to 0.66; 1292 participants; 39 studies). However, effects on motor function are influenced by the type of control intervention. Additionally, based on moderate-quality evidence, mirror therapy may improve activities of daily living (SMD 0.48, 95% CI 0.30 to 0.65; 622 participants; 19 studies). We found low-quality evidence for a significant positive effect on pain (SMD -0.89, 95% CI -1.67 to -0.11; 248 participants; 6 studies) and no clear effect for improving visuospatial neglect (SMD 1.06, 95% CI -0.10 to 2.23; 175 participants; 5 studies). No adverse effects were reported.
The results indicate evidence for the effectiveness of mirror therapy for improving upper extremity motor function, motor impairment, activities of daily living, and pain, at least as an adjunct to conventional rehabilitation for people after stroke. Major limitations are small sample sizes and lack of reporting of methodological details, resulting in uncertain evidence quality.
Relatively new evidence suggests that movement representation techniques (ie, therapies that use the observation and/or imagination of normal pain-free movements, such as mirror therapy, motor ...imagery, or movement and/or action observation) might be effective in reduction of some types of limb pain. To summarize the evidence regarding the efficacy of those techniques, a systematic review with meta-analysis was performed. We searched Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CINAHL, AMED, PsychINFO, Physiotherapy Evidence Database, and OT-seeker up to August 2014 and hand-searched further relevant resources for randomized controlled trials that studied the efficacy of movement representation techniques in reduction of limb pain. The outcomes of interest were pain, disability, and quality of life. Study selection and data extraction were performed by 2 reviewers independently. We included 15 trials on the effects of mirror therapy, (graded) motor imagery, and action observation in patients with complex regional pain syndrome, phantom limb pain, poststroke pain, and nonpathological (acute) pain. Overall, movement representation techniques were found to be effective in reduction of pain (standardized mean difference SMD = -.82, 95% confidence interval CI, -1.32 to -.31, P = .001) and disability (SMD = .72, 95% CI, .22-1.22, P = .004) and showed a positive but nonsignificant effect on quality of life (SMD = 2.61, 85% CI, -3.32 to 8.54, P = .39). Especially mirror therapy and graded motor imagery should be considered for the treatment of patients with complex regional pain syndrome. Furthermore, the results indicate that motor imagery could be considered as a potential effective treatment in patients with acute pain after trauma and surgery. To date, there is no evidence for a pain reducing effect of movement representation techniques in patients with phantom limb pain and poststroke pain other than complex regional pain syndrome.
In this systematic review we synthesize the evidence for the efficacy of movement representation techniques (ie, motor imagery, mirror therapy, or action observation) for treatment of limb pain. Our findings suggest effective pain reduction in some types of limb pain. Further research should address specific questions on the optimal type and dose of therapy.
Abstract Background Stroke is a leading cause of impairment and death. Many survivors suffer from motor, sensory and speech impairments and require ongoing rehabilitation. Digital health ...interventions have the potential to overcome barriers such as distance between patient and therapist. However, there is a lack of clarity in terms and definitions used in research and practice. Therefore, the aim of this scoping review is to provide a comprehensive overview of the definitions and terms used in publications by healthcare professionals (occupational therapy, physiotherapy, speech and language therapy) related to digital stroke rehabilitation. Methods We did a scoping review of all publications related to stroke survivors who received synchronous technology-based distance therapeutic rehabilitation services in physical, occupational therapy, as well as speech and language therapy (PT, OT, SLT). Services were image-based, sensor-based, virtual environment and/or virtual reality-based, and publications were published worldwide in English, French or German between the year 2000 and December 2022, including elaboration of a concept map of the terms and definitions used. Results There is a lack of consistency in terminology and definitions in the field of digital stroke rehabilitation across different countries, languages and professional groups. A preference for the term ‘telerehabilitation’ could be found, as well as a definition. Discussion Although the WHO taxonomy aims to provide a ‚bridging language’ to ensure understanding between different actors, exchange and networking among the therapeutic professions would be necessary to reach a common term for ‚consultations between remote clients and healthcare providers’ in stroke rehabilitation.
Introduction
In speech-language pathology, there is a constant need to make evidence-based decisions based on the patient's needs and goals, speech-language pathologist's clinical expertise, and ...external evidence. During the COVID-19 pandemic, it was possible for the first time in Germany to implement video-based telepractice in the outpatient care of speech-language pathology. This study aimed to find out how evidence-based decisions are made in video-based telepractice and what forms of evidence are used.
Methods
Speech-language pathologists who were working in outpatient services recorded their video-based telepractices for the research project. Five recorded video-based telepractices were transcribed using a simple transcription system and video interaction analysis was used to analyze the video recordings based on grounded theory methodology.
Results
Interactions between patients and speech-language pathologists are characterized by evidence-based decisions that can be observed. Speech-language pathologists make decisions based on their clinical expertise, patient-related experiences, and patient self-assessments. There is little evidence of negotiation between patients and speech-language pathologists to make joint decisions. Results showed that speech-language pathologists do not explicitly name external evidence to justify their decisions to patients. Shared decision-making is encouraged by a participative interaction between patients and speech-language pathologists. However, there was a predominant paternalistic interaction in which the speech-language pathologists made decisions on their own. To represent the decision-based interactions between patients and speech-language pathologists in a video-based therapy session, a process model was developed.
Discussion
Evidence-based and shared decision-making are important in speech-language pathology to provide patient-centered treatments. The exchange of information between the patient and the speech-language pathologist is important in order to make joint decisions based on these different levels of knowledge. In this way, the patient becomes an active participant in the digital treatment, in the video-based telepractice. As a result, the quality of care can be improved. Further research should reconstruct the implicit (possible) use of external evidence.
During the COVID-19 pandemic, videoconferencing as a synchronous form of telepractice service delivery models received a boost. In Germany, online-only sessions are not a standardised means of ...healthcare provision, while telepractice is already well established internationally. This study examines videoconferencing in outpatient speech and language therapy during the first period of the COVID-19 pandemic in Germany. The experiences of therapists are reported in this study.
For this quantitative study, data were collected by an online survey. Speech and language therapists in Germany were surveyed (n = 816). Data were analysed using descriptive statistics.
The results demonstrated that 87% of participants used videoconferencing in the early days of the COVID-19 pandemic. Videoconferencing was conducted with patients of different ages and disorder indications. In their use of videoconferencing, 78% of therapists described benefits. The mentioned benefits and limitations are similar to international findings, showing the potential for synchronous speech and language therapy via videoconferencing. German therapists display a general acceptance of the sustainable use of videoconferencing, and the majority of therapists can imagine transferring videoconferencing to standard healthcare.
Introduction
In Germany, as around the world, the use of digital media in speech and language therapy became part of the service during the COVID-19 pandemic. This resulted in a need for empirical ...studies on the use and acceptance of digital media technologies, to determine users' requirements and concerns regarding the newly mandated technologies, in order to support its expansion in education and training going forward. “Acceptance” has been previously identified as an important aspect behind successful technology adoption. Therefore, two online questionnaire studies were conducted to explore how technology use is accepted among speech and language therapists in Germany.
Methods
Study 1 involved a questionnaire about video therapy with 15 question groupings, examining technology acceptance and competence. From 841 initial respondents, 707 complete responses were included in the analysis. Study 2 involved a different questionnaire, examining technology acceptance and digital media in therapy. In total, 79 individuals participated in the second survey. Study 1 data were analyzed to identify unifying factors underlying respondent attitudes and was followed up with a logistical regression; Study 2 data were analyzed with multiple linear regression.
Results
In Study 1, external inhibiting and facilitating conditions were identified which had an impact on attitudes toward video therapy adoption and its intended future use. In Study 2, the modified model of the Unified Theory of Acceptance and Use of Technology (UTAUT) explained 58.8% of the variability in therapist's Behavioral Intention to Use digital media. Here, Performance Expectancy was a significant predictor.
Conclusions
Both studies investigated facilitating and inhibiting factors for the implementation of digital media including video therapy in future speech therapy services. Results demonstrated that the use is accepted in therapy. Therefore, optimal conditions—both institutional and individual—are needed to enable digital participation for therapists and patients. In future education and training, trainers should focus on the functional aspects of the technologies to be used, in order to positively influence Performance Expectancy in a targeted manner and thus increase the therapists' intention to use digital technology in therapy, which in turn promotes patients' digital participation.
Background
Nowadays, much hope and expectations are associated with digitization in the health sector. The digital change also affects health-related self-help. A nationwide survey of self-help ...organizations (SHOs) aimed to show chances and limitations in the use of interactive IT tools like webforums, online meetings or social media as well as digital infrastructures for their organizational management. In this survey, we also determined whether SHO staff themselves have support and qualification needs with regard to this topic.
Design
The online survey was conducted between 14 November and 8 December 2019, i.e., immediately before the outbreak of the Covid-19 pandemic. The questionnaire consisted of 50 questions consisting of 180 single items which could be answered in 30–40 min. After two reminder letters, 119 questionnaires of the SHOs were gathered and analysed.
Results
SHOs already have a lot of experience with digital media/tools (e.g., own homepage, social media, cloud computing). Some tools are attested a “high” or “very high” benefit by more than 80% of users. Perceived benefits, however, are also facing a number of problems, ranging from lack of resources to data protection issues. Despite, or even because of the limits of digitization, there is great desire and need for support and further training in SHOs (and self-help groups).
Conclusions
At many points in the survey it was shown that digital media can be a useful extension of “traditional” collective self-help. Taking into account the risks and limitations associated with digital tools, SHOs can be central stakeholders in digitization in health-related self-help.
Patient or Public Contribution
The study was financially supported by the Federal Ministry of Health, Germany. A detailed representation of the results is publicly available at: https://www.uke.de/dish.
Pain in sport occurs both as a result of acute injuries and in the form of chronic pain due to overuse or misuse. Pain often occurs in dance and is associated with the high specific strain on the ...musculoskeletal system caused by dance techniques. There is a lack of data on pain-relevant aspects in semi-professional and ambitious popular sports. This applies to dancers and (professional) dance teachers alike. This study aimed to determine pain with regard to prevalence, localisation and development over time in female dancers (T) and dance teachers (TP) engaged in non-professional dance.
This descriptive quantitative cross-sectional observational study was conducted with semi-professional dancers (n = 153) and professional dance teachers (n = 149) in the context of a fully structured anonymous online survey.
More than 70 % of the respondents reported pain in the musculoskeletal system occurring in the context of dancing both within the last 3 and 12 months, with the lower back and knee joints being most frequently and strongly affected. Regarding the development over time, both T and TP predominantly suffered from pain that lasted for more than six months and occurred frequently. In TP, the pain lasted longer, was more likely to occur at rest and was more often associated with limited mobility and resilience compared with the T group.
Regarding prevalence and localisation of pain, the available results are comparable with previous study results from the professional field, both in the TP and T areas. Health risks and (professional) restrictions associated with them are mainly caused by chronic pain development in TP. Therefore, the treatment and management of chronic pain conditions in the healthcare of TP can be very important with regard to their professional participation.
In the campaign to implement evidence-based practice, the current single-hierarchy model of levels of evidence fails to incorporate at parity all types of research evidence that are valuable in the ...practice of occupational therapy. A new model, originally developed by Borgetto et al. (2007) and modified and expanded, is presented. By separating the evidence-level criteria of internal and external validity, by incorporating explicitly the evidence provided by qualitative studies, and by retaining the critical notion of rigor, a pyramidal evidence model emerges. This model, the Research Pyramid, aligns itself with the revised model of evidence-based medicine and, more important, with the basic modes of clinical reasoning in occupational therapy. It constitutes a beginning attempt to order evidence-based practice in accordance with the epistemology of the profession. It may better guide occupational therapy research and meta-synthesis and their incorporation into practice decisions.
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