Mirror therapy versus functional electrical stimulation cycling in post-stroke lower limb rehabilitation: a randomized controlled trial

Background Stroke commonly leads to lower extremity motor impairment and reduced quality of life. Adjunctive rehabilitation approaches are often required to enhance recovery during the subacute phase.Objectives To compare the effects of mirror therapy (MT) and functional electrical stimulation-assisted cycling (FES-C) as adjuncts to conventional rehabilitation in patients with subacute stroke.Methods Forty-five patients were randomly assigned to a control, MT, or FES-C group (n = 15 each). All participants received conventional rehabilitation, with 30 minutes replaced by MT or FES-C in the groups, 5 days per week for six weeks. Outcomes were assessed before and after treatment using the Fugl-Meyer Assessment-Lower Extremity (FMA-LE), Brunnstrom stage, Functional Independence Measure-Motor, Berg Balance Scale, Functional Ambulation Classification, and Stroke-Specific Quality of Life Scale (SS-QOL).Results All groups showed significant within-group improvements (p < 0.05). Compared with control, both the MT (mean difference [MD] −2.60, 95% CI − 5.83 to −0.63, p = 0.004) and FES-C groups (MD − 3.00, 95% CI − 6.23 to −0.23, p = 0.008) demonstrated greater improvements in ΔFMA-LE scores. Only the FES-C group showed significantly greater gains in ΔBrunnstrom stage (MD − 0.80, 95% CI − 1.49 to −0.10, p = 0.007) and ΔSS-QOL (MD − 19.40, 95% CI − 35.70 to −3.09, p = 0.015). No significant differences were observed between MT and FES-C (p > 0.05).Conclusions Despite the more advanced technological features of FES-C, MT also achieved improvements in lower extremity motor function, supporting its use as a simple and accessible adjunct intervention for post-stroke lower extremity rehabilitation.ClinicalTrials.gov NCT06558721Clinical trial registration number The study was registered at the US National Institutes of Health (ClinicalTrials.gov) (NCT06558721) and available a https://clinicaltrials.gov/study/NCT06558721?term=sefa%20c%C4%B1nar&rank=1.