StrokeNCT07428811
Effects of Task-Based Mirror Therapy for Post-stroke Shoulder-Hand Syndrome
A study testing Task based mirror therapy and Conventional exercises in people with Stroke, run by Riphah International University at 2 sites in Pakistan.
Trial summary
The study aims to determine the effects of task-based mirror therapy on edema, pain and upper limb motor function with shoulder-hand syndrome in post stroke patients. This randomized clinical trial will take place at Ittefaq Hospital and Trust Lahore and Alara healthcare clinic, Lahore involving 34 participants aged… Read more about this study
- Who is it for?
- Ages 45 to 75 years
- Conditions the study is for
- Stroke
- What is being tested?
- Task based mirror therapy and Conventional exercises
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 34 participants
- Where
- 2 sitesPakistan
- Study dates
- 5 Nov 2025to 30 Apr 2026
- Phase
- Interventional
- Are there results?
- Not yet: the study is under way
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 45 to 75 years
- All sexes
- No healthy volunteers
- Adult, Older adult
Who may be able to join
- Both male and female patients are included in the study.
- Subacute stroke patients having stroke less than 6 months are included in this study.
- Stable participants having a stroke severity score > 6 on National Institute of Health Stroke Scale (NIHSS).
- Modified Ashworth scale score ≤ 2 of the affected upper extremity.
- Montreal Cognitive Assessment (MoCA) score ≥ 24.
- Patients who can sit with or without support.
- No contractures of the affected shoulder, elbow, wrist and fingers.
- Participants who have no history of peripheral nerve injury or musculoskeletal disease
Who cannot join
- • Participants who have medical problems or co-morbidities that interdict their participation in the study.
- Patients with severe apraxia, somatosensory problems.
- Unilateral neglect
- Severe contractures of the affected shoulder, elbow, wrist and finger.
- Participants who show the symptoms of global or receptive aphasia.
Trial locations and contacts
2 sites in 1 country. Contact the study team or a site near you to ask about taking part.
Pakistan2 sites, 2 recruiting
- Recruiting
Alara healthcare clinic
Lahore, Punjab Province
Maha Sahar, MSPT-NM, 03003424449, mahasahar5@gmail.com
- Recruiting
Ittefaq Hospital and Trust Lahore
Lahore, Punjab Province
Maha Sahar, MSPT-NM, 03003424449, mahasahar5@gmail.com
About this study
Official title: Effects of Task-based Mirror Therapy on Edema, Pain and Upper Limb Motor Function for Post-stroke Shoulder-hand Syndrome
The study aims to determine the effects of task-based mirror therapy on edema, pain and upper limb motor function with shoulder-hand syndrome in post stroke patients.
This randomized clinical trial will take place at Ittefaq Hospital and Trust Lahore and Alara healthcare clinic, Lahore involving 34 participants aged 45-75 years. Using a non-probability convenience sampling method, participants will be randomly assigned by online randomizing tool into two groups: experimental group (17 participants) and control group (17 participants). Both groups will undergo treatment for 30 minutes a day, five days a week, over four weeks. Each task will be performed by repeating each movement 20 times per set for three sets, with a 2-minute break between sets. There will also be 2-minute intervals between each completed task Outcome measures will include pain intensity assessed by the Numeric Pain Rating Scale (NPRS), edema measured by the figure-of-eight method, and upper limb motor function evaluated using the Functional Independence measure (FIM). Assessments will occur at baseline and post-intervention.
Read the detailed description
Stroke is a sudden neurological loss caused by cerebral vascular damage. Upper extremity paralysis is the most prevalent symptom in stroke patients. Stroke-related paralysis is typically caused by internal capsule injury. Neuroplasticity, which involves multiple sections of the brain, is necessary to heal from this damage.Upper extremity function makes up 60% of total body function, with hand function accounting for 90% of that. Shoulder-hand syndrome (SHS), a chronic neurological condition that can develop after a stroke, is defined by excruciating discomfort, edema, vasomotor instability, and impaired motor performance. SHS is often referred to as reflex sympathetic dystrophy of the upper limb or poststroke complicated regional pain syndrome (CRPS). The development of upper limb discomfort and edema observed in SHS was attributed to hemiparetic arms. After a stroke autonomic and motor dysfunction, as well as upper limb pain, can be symptoms of SHS. Pathophysiologic mechanisms may include somatosensory and central autonomic system in brain, peripheral sensitization as hyperexcitability of the afferent fibers and inflammation of peripheral nerves and central mechanism as maladaptive neuroplasticity of motor cortex.
Mirror therapy is an attractive treatment option for clinical practice because it is simple to implement, relatively inexpensive, less intimidating for patients, and often equally or more effective than many alternative treatments. However, not all mirror therapy studies involving stroke victims have yielded such encouraging results. One study observed that the positive effects of mirror therapy decreased over time, and that mirror therapy involving the repetition of simple movements produced improvements during the start of treatment but were followed by a gradual decrease in function as the patients became bored with the movements and began resisting therapy. Based on this observation, mirror therapy programs that incorporate a variety of functional tasks were proposed to be more effective than those involving only simple movements designed to mimic tasks. It was also suggested the use more functional and task-oriented programs that involved picking up a coin because simple movements restrict the functional recovery of more complicated movements performed using the upper extremity. It was observed that treatment was more effective when an actual coin was used rather than when the same motion was performed without a coin.
Traditional rehabilitation methods often inadequately address the specific symptoms of SHS, creating a compelling case for innovative approaches like TBMT. This method uses visual feedback to improve motor function while engaging patients in purposeful, task-oriented exercises. Mirror treatment improves brain plasticity and motor recovery. This study will help us understand the effects of this treatment method and will pay ways for upgraded treatment strategies to improve symptoms and may have better outcomes and prognosis.
- Conditions
- Stroke
- Being tested
- Task based mirror therapy, Conventional exercises
- Keywords
- Edema, pain, shoulder hand syndrome, Task based mirror therapy, upper limb motor function
- Medical subject headings
- Stroke, Edema, Pain, Reflex Sympathetic Dystrophy
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Task based mirror therapyOther
Group A will undergo treatment for 30 minutes a day, five days a week, over four weeks. Each task will be performed by repeating each movement 20 times per set for three sets, with a 2-minute break between sets. There will also be 2-minute intervals between each completed task
Conventional exercisesOther
Group B will undergo treatment for 30 minutes a day, five days a week, over four weeks. Each task will be performed by repeating each movement 20 times per set for three sets, with a 2-minute break between sets. There will also be 2-minute intervals between each completed task
| Study group | Role | What they receive |
|---|---|---|
| Experimental Group A | Experimental | Task based mirror therapy Receives: Other: Task based mirror therapy |
| group B | Active comparator | Conventional exercises Receives: Other: Conventional exercises |
What is being measured
The primary outcome is the main question the study is designed to answer.
Numeric pain rating scale (NPRS)
The Numeric Pain Rating Scale (NPRS) is an effective tool for assessing pain intensity in stroke patients, utilizing a scale from 0 to 10, where 0 indicates "no pain" and 10 represents "the worst pain imaginable." This scale is particularly valuable in stroke populations due to its simplicity and quick administration, allowing for effective communication of pain levels even in individuals with cognitive or physical impairments.
Measured: Baseline
Numeric Pain Rating Scale (NPRS)
The Numeric Pain Rating Scale (NPRS) is an effective tool for assessing pain intensity in stroke patients, utilizing a scale from 0 to 10, where 0 indicates "no pain" and 10 represents "the worst pain imaginable." This scale is particularly valuable in stroke populations due to its simplicity and quick administration, allowing for effective communication of pain levels even in individuals with cognitive or physical impairments.
Measured: 4 weeks
Secondary outcomes (4)
Figure of 8 measurement method
Figure 8 measurement method is a practical technique used to assess edema in the hand, particularly following a stroke. This method involves wrapping a flexible measuring tape around the hand and wrist in a figure-eight pattern, allowing for consistent measurements at specific anatomical points. It begins by placing the tape at the ulnar aspect of the wrist, passing it across the palm and around the fingers, and then returning to the starting point. Abnormal values indicating edema may be defined as an increase of more than 1-2 cm compared to the unaffected hand, signifying potential swelling due to conditions such as stroke, trauma, or inflammation
Measured: Baseline
Figure of 8 measurement method
Figure 8 measurement method is a practical technique used to assess edema in the hand, particularly following a stroke. This method involves wrapping a flexible measuring tape around the hand and wrist in a figure-eight pattern, allowing for consistent measurements at specific anatomical points. It begins by placing the tape at the ulnar aspect of the wrist, passing it across the palm and around the fingers, and then returning to the starting point. Abnormal values indicating edema may be defined as an increase of more than 1-2 cm compared to the unaffected hand, signifying potential swelling due to conditions such as stroke, trauma, or inflammation
Measured: 4 weeks
Functional independence measure [FIM]
The Functional Independence Measure (FIM) assesses a patient's level of independence in daily activities following a stroke. It includes various domains such as self-care, mobility, and social cognition. An admission FIM score > 70 has been associated with achieving non-dependence by discharge whereas those with an admission score < 50 remained dependent
Measured: Baseline
Functional Independence Measure (FIM)
The Functional Independence Measure (FIM) assesses a patient's level of independence in daily activities following a stroke. It includes various domains such as self-care, mobility, and social cognition. An admission FIM score > 70 has been associated with achieving non-dependence by discharge whereas those with an admission score < 50 remained dependent
Measured: 4 weeks
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted24 Feb 2026
- Study start5 Nov 2025
- Primary completion12 Apr 2026 (estimated)
- Study completion30 Apr 2026 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (5)Papers the sponsor has linked to this study.
- Other trials for StrokeStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Double blind
- Who is masked
- Participant, Outcomes assessor
- Enrolment
- 34 participants (estimated)
Sponsor and investigators
- Lead sponsor
- Riphah International University
- Sponsor type
- University, hospital or other
- Responsible party
- Sponsor
- Investigators
- Binash Afzal, PHD, Principal investigator, Riphah International University
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT07428811
- Sponsor's protocol ID
- REC/0285 Maha Sahar
- Status last verified
- Feb 2026
- First submitted
- 8 Dec 2025
- Last updated
- 24 Feb 2026
- Results posted
- No
- Data monitoring committee
- Yes
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No
Publications
Lee JI, Kwon SW, Lee A, Tae WS, Pyun SB. Neuroanatomical correlates of poststroke complex regional pain syndrome: a voxel-based lesion symptom-mapping study. Sci Rep. 2021 Jun 22;11(1):13093. doi: 10.1038/s41598-021-92564-7.
PubMed 34158602Li L, Li J, He M. Treatment outcomes in post-stroke shoulder-hand syndrome: The role of combined acupuncture, traditional Chinese herb hot compress and rehabilitation training. J Back Musculoskelet Rehabil. 2024;37(4):1023-1030. doi: 10.3233/BMR-230267.
PubMed 38517771Feng S, Tang M, Huang G, Wang J, He S, Liu D, Gu L. EMG biofeedback combined with rehabilitation training may be the best physical therapy for improving upper limb motor function and relieving pain in patients with the post-stroke shoulder-hand syndrome: A Bayesian network meta-analysis. Front Neurol. 2023 Jan 10;13:1056156. doi: 10.3389/fneur.2022.1056156. eCollection 2022.
PubMed 36703623Saha S, Sur M, Ray Chaudhuri G, Agarwal S. Effects of mirror therapy on oedema, pain and functional activities in patients with poststroke shoulder-hand syndrome: A randomized controlled trial. Physiother Res Int. 2021 Jul;26(3):e1902. doi: 10.1002/pri.1902. Epub 2021 Mar 6.
PubMed 33675672Liu H, Xu Y, Jiang W, Hu F, Zhou Y, Pan L, Zhou F, Yin Y, Tan B. Effects of task-based mirror therapy on upper limb motor function in hemiplegia: study protocol for a randomized controlled clinical trial. Trials. 2024 Apr 11;25(1):254. doi: 10.1186/s13063-024-08081-1.
PubMed 38605413
Study at a glance
From the registry record, last updated by the sponsor on 24 Feb 2026. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Effects of Task-based Mirror Therapy on Edema, Pain and Upper Limb Motor Function for Post-stroke Shoulder-hand Syndrome
- ClinicalTrials.gov ID
- NCT07428811
- Acronym / sponsor ID
- REC/0285 Maha Sahar
- Conditions
- Stroke
- Keywords
- Edema, pain, shoulder hand syndrome, Task based mirror therapy, upper limb motor function
- Study type
- Interventional
- Recruitment status
- Recruiting
- Enrolment
- 34 participants (estimated)
- Lead sponsor
- Riphah International UniversityUniversity, hospital or other
- Study start
- 5 Nov 2025 (actual)
- Primary completion
- 12 Apr 2026 (estimated)
- Study completion
- 30 Apr 2026 (estimated)
- First posted
- 24 Feb 2026 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
The study aims to determine the effects of task-based mirror therapy on edema, pain and upper limb motor function with shoulder-hand syndrome in post stroke patients.
This randomized clinical trial will take place at Ittefaq Hospital and Trust Lahore and Alara healthcare clinic, Lahore involving 34 participants aged 45-75 years. Using a non-probability convenience sampling method, participants will be randomly assigned by online randomizing tool into two groups: experimental group (17 participants) and control group (17 participants). Both groups will undergo treatment for 30 minutes a day, five days a week, over four weeks. Each task will be performed by repeating each movement 20 times per set for three sets, with a 2-minute break between sets. There will also be 2-minute intervals between each completed task Outcome measures will include pain intensity assessed by the Numeric Pain Rating Scale (NPRS), edema measured by the figure-of-eight method, and upper limb motor function evaluated using the Functional Independence measure (FIM). Assessments will occur at baseline and post-intervention.
Detailed description
Stroke is a sudden neurological loss caused by cerebral vascular damage. Upper extremity paralysis is the most prevalent symptom in stroke patients. Stroke-related paralysis is typically caused by internal capsule injury. Neuroplasticity, which involves multiple sections of the brain, is necessary to heal from this damage.Upper extremity function makes up 60% of total body function, with hand function accounting for 90% of that. Shoulder-hand syndrome (SHS), a chronic neurological condition that can develop after a stroke, is defined by excruciating discomfort, edema, vasomotor instability, and impaired motor performance. SHS is often referred to as reflex sympathetic dystrophy of the upper limb or poststroke complicated regional pain syndrome (CRPS). The development of upper limb discomfort and edema observed in SHS was attributed to hemiparetic arms. After a stroke autonomic and motor dysfunction, as well as upper limb pain, can be symptoms of SHS. Pathophysiologic mechanisms may include somatosensory and central autonomic system in brain, peripheral sensitization as hyperexcitability of the afferent fibers and inflammation of peripheral nerves and central mechanism as maladaptive neuroplasticity of motor cortex.
Mirror therapy is an attractive treatment option for clinical practice because it is simple to implement, relatively inexpensive, less intimidating for patients, and often equally or more effective than many alternative treatments. However, not all mirror therapy studies involving stroke victims have yielded such encouraging results. One study observed that the positive effects of mirror therapy decreased over time, and that mirror therapy involving the repetition of simple movements produced improvements during the start of treatment but were followed by a gradual decrease in function as the patients became bored with the movements and began resisting therapy. Based on this observation, mirror therapy programs that incorporate a variety of functional tasks were proposed to be more effective than those involving only simple movements designed to mimic tasks. It was also suggested the use more functional and task-oriented programs that involved picking up a coin because simple movements restrict the functional recovery of more complicated movements performed using the upper extremity. It was observed that treatment was more effective when an actual coin was used rather than when the same motion was performed without a coin.
Traditional rehabilitation methods often inadequately address the specific symptoms of SHS, creating a compelling case for innovative approaches like TBMT. This method uses visual feedback to improve motor function while engaging patients in purposeful, task-oriented exercises. Mirror treatment improves brain plasticity and motor recovery. This study will help us understand the effects of this treatment method and will pay ways for upgraded treatment strategies to improve symptoms and may have better outcomes and prognosis.
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Double blind (participant, outcomes assessor)
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| Experimental Group A | Experimental | Other: Task based mirror therapyTask based mirror therapy |
| group B | Active comparator | Other: Conventional exercisesConventional exercises |
Who may qualify
- Ages
- 45 to 75 years
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (8 listed)
- Both male and female patients are included in the study.
- Subacute stroke patients having stroke less than 6 months are included in this study.
- Stable participants having a stroke severity score > 6 on National Institute of Health Stroke Scale (NIHSS).
- Modified Ashworth scale score ≤ 2 of the affected upper extremity.
- Montreal Cognitive Assessment (MoCA) score ≥ 24.
Key exclusion criteria (5 listed)
- • Participants who have medical problems or co-morbidities that interdict their participation in the study.
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Task based mirror therapyGroup A will undergo treatment for 30 minutes a day, five days a week, over four weeks. Each task will be performed by repeating each movement 20 times per set for three sets, with a 2-minute break between sets. There will also be 2-minute intervals between each completed task | Other | Experimental Group A |
| Conventional exercisesGroup B will undergo treatment for 30 minutes a day, five days a week, over four weeks. Each task will be performed by repeating each movement 20 times per set for three sets, with a 2-minute break between sets. There will also be 2-minute intervals between each completed task | Other | group B |
Primary outcome
Numeric pain rating scale (NPRS)
Time frame: Baseline
The Numeric Pain Rating Scale (NPRS) is an effective tool for assessing pain intensity in stroke patients, utilizing a scale from 0 to 10, where 0 indicates "no pain" and 10 represents "the worst pain imaginable." This scale is particularly valuable in stroke populations due to its simplicity and quick administration, allowing for effective communication of pain levels even in individuals with cognitive or physical impairments.
Numeric Pain Rating Scale (NPRS)
Time frame: 4 weeks
The Numeric Pain Rating Scale (NPRS) is an effective tool for assessing pain intensity in stroke patients, utilizing a scale from 0 to 10, where 0 indicates "no pain" and 10 represents "the worst pain imaginable." This scale is particularly valuable in stroke populations due to its simplicity and quick administration, allowing for effective communication of pain levels even in individuals with cognitive or physical impairments.
4 secondary outcomes
Figure of 8 measurement method
Time frame: Baseline
Figure of 8 measurement method
Time frame: 4 weeks
Functional independence measure [FIM]
Time frame: Baseline
Functional Independence Measure (FIM)
Time frame: 4 weeks
Results and safety
This study is still under way. Results are not available in the source record yet.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 24 Feb 2026.
- Background: PubMed 34158602Lee JI, Kwon SW, Lee A, Tae WS, Pyun SB. Neuroanatomical correlates of poststroke complex regional pain syndrome: a voxel-based lesion symptom-mapping study. Sci Rep. 2021 Jun 22;11(1):13093. doi: 10.1038/s41598-021-92564-7.
- Background: PubMed 38517771Li L, Li J, He M. Treatment outcomes in post-stroke shoulder-hand syndrome: The role of combined acupuncture, traditional Chinese herb hot compress and rehabilitation training. J Back Musculoskelet Rehabil. 2024;37(4):1023-1030. doi: 10.3233/BMR-230267.
- Background: PubMed 36703623Feng S, Tang M, Huang G, Wang J, He S, Liu D, Gu L. EMG biofeedback combined with rehabilitation training may be the best physical therapy for improving upper limb motor function and relieving pain in patients with the post-stroke shoulder-hand syndrome: A Bayesian network meta-analysis. Front Neurol. 2023 Jan 10;13:1056156. doi: 10.3389/fneur.2022.1056156. eCollection 2022.
- Background: PubMed 33675672Saha S, Sur M, Ray Chaudhuri G, Agarwal S. Effects of mirror therapy on oedema, pain and functional activities in patients with poststroke shoulder-hand syndrome: A randomized controlled trial. Physiother Res Int. 2021 Jul;26(3):e1902. doi: 10.1002/pri.1902. Epub 2021 Mar 6.
- Background: PubMed 38605413Liu H, Xu Y, Jiang W, Hu F, Zhou Y, Pan L, Zhou F, Yin Y, Tan B. Effects of task-based mirror therapy on upper limb motor function in hemiplegia: study protocol for a randomized controlled clinical trial. Trials. 2024 Apr 11;25(1):254. doi: 10.1186/s13063-024-08081-1.
- Individual participant dataSharing planned: No
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part.
Binash Afzal, PHD principal investigator
Riphah International University
2 sites in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Task based mirror therapy and Conventional exercises in people with Stroke, run by Riphah International University at 2 sites in Pakistan.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 8 inclusion and 5 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: looking for participants now, as of the sponsor's last update on 24 Feb 2026. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 2 sites in Pakistan. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
This study is still under way. Results are not available in the source record yet.
How can a doctor refer a patient or contact the research team?
Contact Maha Sahar, MSPT-NM (03003424449, mahasahar5@gmail.com), or a site near the patient. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Numeric pain rating scale (NPRS) (time frame: Baseline). The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT07428811, which also lists 5 linked publications.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 24 Feb 2026.