StrokeNCT07641803
Mirror Therapy Versus Action Observation Therapy on Upper Limb Motor Function, Functional Independence, and Quality Oflife Among Chronic Stroke Patients
A study testing Mirror Therapy and Action Observation Therapy in people with Stroke, run by University of Lahore at 1 site in Pakistan.
Trial summary
This randomized controlled trial aims to compare the effects of Mirror Therapy (MT) and Action Observation Therapy (AOT) on upper limb motor function, functional independence, and health-related quality of life in individuals with chronic stroke. Read more about this study
- Who is it for?
- Ages 45 to 75 years
- Conditions the study is for
- Stroke
- What is being tested?
- Mirror Therapy and Action Observation Therapy
- Type of treatment
- Lifestyle or therapy programme
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 76 participants
- Where
- 1 sitePakistan
- Study dates
- 3 Feb 2025to 28 Apr 2026
- Phase
- Interventional
- Are there results?
- None posted in the registry
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
- Individuals diagnosed with chronic stroke (≥6 months post-stroke).
- Patients with stroke affecting either the left or right upper limb will be included.
- Mild-to-moderate upper limb motor impairment (Fugl-Meyer Upper Extremity Score between 19-55).
- Ability to follow verbal and visual instructions.
- Medically stable with no active comorbidities affecting rehabilitation (Tang et al., 2024).
Who cannot join
- Severe cognitive or communication impairments prevent task understanding.
- Presence of severe upper limb spasticity or contractures.
- History of severe visual or perceptual deficits (e.g., neglect, hemianopia).
- Uncontrolled epilepsy or active psychiatric disorders.
- Participation in other upper limb rehabilitation programs during the study period.
Trial locations and contacts
1 site in 1 country.
About this study
This randomized controlled trial aims to compare the effects of Mirror Therapy (MT) and Action Observation Therapy (AOT) on upper limb motor function, functional independence, and health-related quality of life in individuals with chronic stroke. Stroke-related upper limb impairment remains a major cause of long-term disability and reduced independence. Both MT and AOT are neurocognitive rehabilitation approaches based on activation of the mirror neuron system and promotion of neuroplasticity. Eligible participants with chronic stroke will be randomly allocated to either a Mirror Therapy group or an Action Observation Therapy group and will receive supervised interventions in addition to standard physiotherapy. Outcomes will be assessed using the Motor Evaluation Scale for Upper Extremity in Stroke Patients (MESUPES), Fugl-Meyer Assessment for Upper Extremity (FMA-UE), and Short Form-36 Health Survey (SF-36). The study seeks to determine the comparative effectiveness of these interventions for improving upper limb function, functional independence, and quality of life among chronic stroke survivors.
Read the detailed description
Stroke is a leading cause of long-term disability worldwide and frequently results in persistent upper limb impairments that limit functional independence and participation in daily activities. Despite advances in rehabilitation, many stroke survivors continue to experience deficits in motor control, coordination, dexterity, and upper extremity function, particularly during the chronic phase of recovery. Therefore, identifying effective rehabilitation strategies that promote neuroplasticity and enhance motor recovery remains a priority in stroke rehabilitation.
Mirror Therapy (MT) and Action Observation Therapy (AOT) are neurocognitive rehabilitation interventions that have gained increasing attention because of their potential to facilitate motor recovery through activation of the mirror neuron system. Mirror Therapy involves observation of the reflection of movements performed by the unaffected limb, creating the visual illusion that the affected limb is moving normally. This visual feedback is believed to stimulate motor cortical areas and promote motor relearning. Action Observation Therapy involves observation of goal-directed motor tasks performed by another individual, followed by active imitation of the observed movements. Through observation and execution of actions, AOT is intended to enhance motor planning, motor learning, and cortical reorganization.
Although both interventions have demonstrated potential benefits in stroke rehabilitation, limited evidence exists directly comparing their effectiveness for improving upper limb function, functional independence, and quality of life among individuals with chronic stroke. This study has been designed to address this gap by evaluating and comparing the clinical effects of MT and AOT within a randomized controlled trial framework.
The study will be conducted at Goshe Shifa Hospital, Lahore, Pakistan. Participants diagnosed with chronic stroke (six months or more post-stroke), aged 45-75 years, with mild-to-moderate upper limb motor impairment, will be screened for eligibility. Eligible participants will be randomly assigned to one of two intervention groups using a computer-generated randomization sequence with allocation concealment through sealed opaque envelopes.
Participants allocated to the Mirror Therapy group will receive a structured upper limb rehabilitation program utilizing mirror-induced visual feedback. Sessions will include simple upper limb movements, functional activities, and task-specific training performed while observing the mirror reflection of the unaffected limb. Participants allocated to the Action Observation Therapy group will observe videos demonstrating goal-directed upper limb activities and subsequently practice the observed tasks under physiotherapy supervision.
Both interventions will be delivered for six weeks, five sessions per week, with each session lasting approximately 45 minutes. Outcome assessments will be performed at baseline and after completion of the intervention period by assessors blinded to group allocation.
The primary outcomes of interest include upper limb motor function, functional independence, and health-related quality of life. These outcomes will be measured using the Motor Evaluation Scale for Upper Extremity in Stroke Patients (MESUPES), Fugl-Meyer Assessment for Upper Extremity (FMA-UE), and Short Form-36 Health Survey (SF-36), respectively.
The study is expected to contribute evidence regarding the comparative effectiveness of two widely used neurorehabilitation approaches and may assist clinicians in selecting appropriate interventions for upper limb rehabilitation in individuals with chronic stroke.
- Conditions
- Stroke
- Being tested
- Mirror Therapy, Action Observation Therapy
- Keywords
- Action Observation, Chronic Stroke, Mirror Therapy, Motor Recovery, Quality of Life
- Medical subject headings
- Stroke
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Mirror TherapyBehavioural
Participants assigned to the Mirror Therapy intervention will receive supervised upper limb rehabilitation using mirror-induced visual feedback. A mirror will be positioned in the participant's midline, allowing observation of the reflection of the unaffected upper limb while the affected limb remains hidden. Sessions will include simple joint movements, functional tasks, and task-specific activities designed to promote motor relearning and cortical reorganization. Treatment will be delivered for 45 minutes per session, five days per week, for six weeks, alongside standard physiotherapy.
Action Observation TherapyBehavioural
Participants assigned to the Action Observation Therapy intervention will observe videos demonstrating goal-directed upper limb activities and subsequently practice the observed movements under physiotherapist supervision. The intervention consists of an observation phase, guided imitation, and repetitive task practice to facilitate motor learning and neuroplasticity. Treatment sessions will last 45 minutes and will be conducted five days per week for six weeks in addition to standard physiotherapy.
| Study group | Role | What they receive |
|---|---|---|
| Mirror Therapy Group | Experimental | Participants assigned to this group will receive Mirror Therapy in addition to standard physiotherapy. A mirror will be positioned in the midline so that movements of the unaffected upper limb are reflected, creating the visual illusion that the affected limb is moving normally. Treatment sessions will last 45 minutes, five days per week for six weeks. The intervention will include simple joint movements, functional upper limb activities, and task-specific training designed to promote motor recovery, functional independence, and neuroplasticity. Receives: Behavioral: Mirror Therapy |
| Action Observation Therapy Group | Experimental | Participants assigned to this group will receive Action Observation Therapy in addition to standard physiotherapy. Participants will observe videos demonstrating goal-directed upper limb activities and subsequently imitate the observed movements under physiotherapist supervision. Treatment sessions will last 45 minutes, five days per week for six weeks. The intervention will include observation, guided imitation, and repetitive practice of functional tasks aimed at improving motor planning, motor execution, upper limb function, and functional independence. Receives: Behavioral: Action Observation Therapy |
What is being measured
The primary outcome is the main question the study is designed to answer.
Upper Limb Motor Function
Upper limb motor function will be assessed using the Motor Evaluation Scale for Upper Extremity in Stroke Patients (MESUPES). Higher scores indicate better upper extremity motor performance and functional ability.
Measured: Baseline and 6 weeks (end of intervention)
Upper Extremity Motor Recovery
Motor recovery will be evaluated using the Fugl-Meyer Assessment for Upper Extremity (FMA-UE). The scale assesses motor impairment, coordination, reflex activity, and voluntary movement, with higher scores indicating improved motor recovery.
Measured: Baseline and 6 weeks (end of intervention)
Secondary outcomes (1)
Health-Related Quality of Life
Health-related quality of life will be measured using the Short Form-36 Health Survey (SF-36). The questionnaire evaluates physical and mental health domains, with higher scores representing better perceived health status and quality of life.
Measured: Baseline and 6 weeks (end of intervention)
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted11 Jun 2026
- Study start3 Feb 2025
- Primary completion19 Mar 2026
- Study completion28 Apr 2026
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (4)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
- Single blind
- Who is masked
- Outcomes assessor
- Enrolment
- 76 participants (actual)
Sponsor and investigators
- Lead sponsor
- University of Lahore
- Sponsor type
- University, hospital or other
- Responsible party
- Sponsor
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT07641803
- Sponsor's protocol ID
- UOL/IREB/25/09/0032
- Status last verified
- Jun 2026
- First submitted
- 6 Jun 2026
- Last updated
- 11 Jun 2026
- Results posted
- No
- Data monitoring committee
- Yes
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No
Publications
Binks JA, Emerson JR, Scott MW, Wilson C, van Schaik P, Eaves DL. Enhancing upper-limb neurorehabilitation in chronic stroke survivors using combined action observation and motor imagery therapy. Front Neurol. 2023 Mar 2;14:1097422. doi: 10.3389/fneur.2023.1097422. eCollection 2023.
PubMed 36937513Effectiveness of Home-Based Mirror Therapy on Enhancing the Upper Limb Sensory- Motor Recovery of Elderly Patients Post-Stroke. Assiut Scientific Nursing Journal, 12(41), 137-149.
Kim YS, Song JY, Park SH, Lee MM. Effect of functional electrical stimulation-based mirror therapy using gesture recognition biofeedback on upper extremity function in patients with chronic stroke: A randomized controlled trial. Medicine (Baltimore). 2023 Dec 29;102(52):e36546. doi: 10.1097/MD.0000000000036546.
PubMed 38206692Tang E, Moran N, Cadman M, Hill S, Sloan C, Warburton E; guideline committee. Stroke rehabilitation in adults: summary of updated NICE guidance. BMJ. 2024 Mar 22;384:q498. doi: 10.1136/bmj.q498. No abstract available.
PubMed 38519084
Study at a glance
From the registry record, last updated by the sponsor on 11 Jun 2026. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Mirror Therapy Versus Action Observation Therapy on Upper Limb Motor Function, Functional Independence, and Quality Oflife Among Chronic Stroke Patients
- ClinicalTrials.gov ID
- NCT07641803
- Acronym / sponsor ID
- UOL/IREB/25/09/0032
- Conditions
- Stroke
- Keywords
- Action Observation, Chronic Stroke, Mirror Therapy, Motor Recovery, Quality of Life
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 76 participants (actual)
- Lead sponsor
- University of LahoreUniversity, hospital or other
- Study start
- 3 Feb 2025 (actual)
- Primary completion
- 19 Mar 2026 (actual)
- Study completion
- 28 Apr 2026 (actual)
- First posted
- 11 Jun 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.
This randomized controlled trial aims to compare the effects of Mirror Therapy (MT) and Action Observation Therapy (AOT) on upper limb motor function, functional independence, and health-related quality of life in individuals with chronic stroke. Stroke-related upper limb impairment remains a major cause of long-term disability and reduced independence. Both MT and AOT are neurocognitive rehabilitation approaches based on activation of the mirror neuron system and promotion of neuroplasticity. Eligible participants with chronic stroke will be randomly allocated to either a Mirror Therapy group or an Action Observation Therapy group and will receive supervised interventions in addition to standard physiotherapy. Outcomes will be assessed using the Motor Evaluation Scale for Upper Extremity in Stroke Patients (MESUPES), Fugl-Meyer Assessment for Upper Extremity (FMA-UE), and Short Form-36 Health Survey (SF-36). The study seeks to determine the comparative effectiveness of these interventions for improving upper limb function, functional independence, and quality of life among chronic stroke survivors.
Detailed description
Stroke is a leading cause of long-term disability worldwide and frequently results in persistent upper limb impairments that limit functional independence and participation in daily activities. Despite advances in rehabilitation, many stroke survivors continue to experience deficits in motor control, coordination, dexterity, and upper extremity function, particularly during the chronic phase of recovery. Therefore, identifying effective rehabilitation strategies that promote neuroplasticity and enhance motor recovery remains a priority in stroke rehabilitation.
Mirror Therapy (MT) and Action Observation Therapy (AOT) are neurocognitive rehabilitation interventions that have gained increasing attention because of their potential to facilitate motor recovery through activation of the mirror neuron system. Mirror Therapy involves observation of the reflection of movements performed by the unaffected limb, creating the visual illusion that the affected limb is moving normally. This visual feedback is believed to stimulate motor cortical areas and promote motor relearning. Action Observation Therapy involves observation of goal-directed motor tasks performed by another individual, followed by active imitation of the observed movements. Through observation and execution of actions, AOT is intended to enhance motor planning, motor learning, and cortical reorganization.
Although both interventions have demonstrated potential benefits in stroke rehabilitation, limited evidence exists directly comparing their effectiveness for improving upper limb function, functional independence, and quality of life among individuals with chronic stroke. This study has been designed to address this gap by evaluating and comparing the clinical effects of MT and AOT within a randomized controlled trial framework.
The study will be conducted at Goshe Shifa Hospital, Lahore, Pakistan. Participants diagnosed with chronic stroke (six months or more post-stroke), aged 45-75 years, with mild-to-moderate upper limb motor impairment, will be screened for eligibility. Eligible participants will be randomly assigned to one of two intervention groups using a computer-generated randomization sequence with allocation concealment through sealed opaque envelopes.
Participants allocated to the Mirror Therapy group will receive a structured upper limb rehabilitation program utilizing mirror-induced visual feedback. Sessions will include simple upper limb movements, functional activities, and task-specific training performed while observing the mirror reflection of the unaffected limb. Participants allocated to the Action Observation Therapy group will observe videos demonstrating goal-directed upper limb activities and subsequently practice the observed tasks under physiotherapy supervision.
Both interventions will be delivered for six weeks, five sessions per week, with each session lasting approximately 45 minutes. Outcome assessments will be performed at baseline and after completion of the intervention period by assessors blinded to group allocation.
The primary outcomes of interest include upper limb motor function, functional independence, and health-related quality of life. These outcomes will be measured using the Motor Evaluation Scale for Upper Extremity in Stroke Patients (MESUPES), Fugl-Meyer Assessment for Upper Extremity (FMA-UE), and Short Form-36 Health Survey (SF-36), respectively.
The study is expected to contribute evidence regarding the comparative effectiveness of two widely used neurorehabilitation approaches and may assist clinicians in selecting appropriate interventions for upper limb rehabilitation in individuals with chronic stroke.
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Single blind (outcomes assessor)
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| Mirror Therapy Group | Experimental | Behavioral: Mirror TherapyParticipants assigned to this group will receive Mirror Therapy in addition to standard physiotherapy. A mirror will be positioned in the midline so that movements of the unaffected upper limb are reflected, creating the visual illusion that the affected limb is moving normally. Treatment sessions will last 45 minutes, five days per week for six weeks. The intervention will include simple joint movements, functional upper limb activities, and task-specific training designed to promote motor recovery, functional independence, and neuroplasticity. |
| Action Observation Therapy Group | Experimental | Behavioral: Action Observation TherapyParticipants assigned to this group will receive Action Observation Therapy in addition to standard physiotherapy. Participants will observe videos demonstrating goal-directed upper limb activities and subsequently imitate the observed movements under physiotherapist supervision. Treatment sessions will last 45 minutes, five days per week for six weeks. The intervention will include observation, guided imitation, and repetitive practice of functional tasks aimed at improving motor planning, motor execution, upper limb function, and functional independence. |
Who may qualify
- Ages
- 45 to 75 years
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (5 listed)
- Individuals diagnosed with chronic stroke (≥6 months post-stroke).
- Patients with stroke affecting either the left or right upper limb will be included.
- Mild-to-moderate upper limb motor impairment (Fugl-Meyer Upper Extremity Score between 19-55).
- Ability to follow verbal and visual instructions.
- Medically stable with no active comorbidities affecting rehabilitation (Tang et al., 2024).
Key exclusion criteria (5 listed)
- Severe cognitive or communication impairments prevent task understanding.
- Presence of severe upper limb spasticity or contractures.
- History of severe visual or perceptual deficits (e.g., neglect, hemianopia).
- Uncontrolled epilepsy or active psychiatric disorders.
- Participation in other upper limb rehabilitation programs during the study period.
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 |
|---|---|---|
| Mirror TherapyParticipants assigned to the Mirror Therapy intervention will receive supervised upper limb rehabilitation using mirror-induced visual feedback. A mirror will be positioned in the participant's midline, allowing observation of the reflection of the unaffected upper limb while the affected limb remains hidden. Sessions will include simple joint movements, functional tasks, and task-specific activities designed to promote motor relearning and cortical reorganization. Treatment will be delivered for 45 minutes per session, five days per week, for six weeks, alongside standard physiotherapy. | Behavioural | Mirror Therapy Group |
| Action Observation TherapyParticipants assigned to the Action Observation Therapy intervention will observe videos demonstrating goal-directed upper limb activities and subsequently practice the observed movements under physiotherapist supervision. The intervention consists of an observation phase, guided imitation, and repetitive task practice to facilitate motor learning and neuroplasticity. Treatment sessions will last 45 minutes and will be conducted five days per week for six weeks in addition to standard physiotherapy. | Behavioural | Action Observation Therapy Group |
Primary outcome
Upper Limb Motor Function
Time frame: Baseline and 6 weeks (end of intervention)
Upper limb motor function will be assessed using the Motor Evaluation Scale for Upper Extremity in Stroke Patients (MESUPES). Higher scores indicate better upper extremity motor performance and functional ability.
Upper Extremity Motor Recovery
Time frame: Baseline and 6 weeks (end of intervention)
Motor recovery will be evaluated using the Fugl-Meyer Assessment for Upper Extremity (FMA-UE). The scale assesses motor impairment, coordination, reflex activity, and voluntary movement, with higher scores indicating improved motor recovery.
1 secondary outcome
Health-Related Quality of Life
Time frame: Baseline and 6 weeks (end of intervention)
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 11 Jun 2026.
- Background: PubMed 36937513Binks JA, Emerson JR, Scott MW, Wilson C, van Schaik P, Eaves DL. Enhancing upper-limb neurorehabilitation in chronic stroke survivors using combined action observation and motor imagery therapy. Front Neurol. 2023 Mar 2;14:1097422. doi: 10.3389/fneur.2023.1097422. eCollection 2023.
- BackgroundEffectiveness of Home-Based Mirror Therapy on Enhancing the Upper Limb Sensory- Motor Recovery of Elderly Patients Post-Stroke. Assiut Scientific Nursing Journal, 12(41), 137-149.
- Background: PubMed 38206692Kim YS, Song JY, Park SH, Lee MM. Effect of functional electrical stimulation-based mirror therapy using gesture recognition biofeedback on upper extremity function in patients with chronic stroke: A randomized controlled trial. Medicine (Baltimore). 2023 Dec 29;102(52):e36546. doi: 10.1097/MD.0000000000036546.
- Background: PubMed 38519084Tang E, Moran N, Cadman M, Hill S, Sloan C, Warburton E; guideline committee. Stroke rehabilitation in adults: summary of updated NICE guidance. BMJ. 2024 Mar 22;384:q498. doi: 10.1136/bmj.q498. No abstract available.
- 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. This study is not recruiting at the moment.
The record lists no contact. Use the official record to reach the sponsor.
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Mirror Therapy and Action Observation Therapy in people with Stroke, run by University of Lahore at 1 site 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 5 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: finished, as of the sponsor's last update on 11 Jun 2026. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site 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?
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Upper Limb Motor Function (time frame: Baseline and 6 weeks (end of intervention)). 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 NCT07641803, which also lists 4 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 11 Jun 2026.