Comparative Effectiveness of the Motor Relearning Program and Mirror Therapy for Upper-Extremity Recovery After Stroke: A Systematic Review Without Meta-Analysis
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Background: Upper-extremity impairment frequently persists after stroke and restricts independence in daily activities. Although the Motor Relearning Program (MRP) and Mirror Therapy (MT) are accessible rehabilitation approaches, their comparative effectiveness remains uncertain. Objective: To systematically review randomized direct-comparison studies evaluating MRP versus MT for upper-extremity motor and functional recovery after stroke. Methods: PubMed/MEDLINE, Scopus, Web of Science, PEDro, CENTRAL, ScienceDirect, and Google Scholar were searched from inception through August 2026. Randomized trials involving adults with post-stroke upper-extremity impairment and directly comparing MRP with MT were eligible. Two reviewers independently screened studies, extracted data, and assessed risk of bias using Cochrane RoB 2. Because compatible between-group estimates and measures of variance were insufficient for statistical pooling, findings were synthesized without meta-analysis according to outcome domain and comparison type. Results: Six studies involving 211 participants were included; 196 participants contributed to the direct comparison, with 98 receiving MRP and 98 receiving MT. All studies had some risk-of-bias concerns. Direct pairwise findings favored MRP for upper-arm function (p<0.001 and p=0.001) and hand function (p<0.001 and p=0.004) in two studies. Findings for advanced hand activities were inconsistent (p<0.001 and p=0.070). FMA-UE and CAHAI evidence was inconclusive because several studies reported only within-group or omnibus comparisons. No pooled effect estimates were calculated. Conclusion: MRP may provide greater improvement than MT in selected upper-arm and hand-function outcomes, but the evidence does not establish overall superiority. Larger, prospectively registered trials reporting standardized between-group estimates and longer-term outcomes are required
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