Implementing Mirror Therapy and Mental Imagery for Stroke Inpatient Rehabilitation: Adoption, Acceptability, and Feasibility

Importance Mirror therapy and mental imagery (MTMI) are evidence-based interventions for upper extremity motor recovery after stroke, yet they remain underused in clinical practice. Implementation science offers a systematic approach in improving uptake in real-world settings. Objective To evaluate the changes in clinician acceptability, feasibility, adoption, and patient reach of MTMI over 12 months. Design Prospective, single-site implementation evaluation guided by implementation science frameworks. Setting A free-standing inpatient rehabilitation hospital. Participants Occupational therapists ( n = 16) and adult inpatients with stroke or similar neurological conditions. Intervention A therapist-led, 60 min MTMI group was delivered two to three times weekly. Six implementation barriers were identified. Implementation strategies: clinician education, training, support, and infrastructure changes. Outcomes and Measures Therapist acceptability and feasibility were measured using the Acceptability of Intervention Measure (AIM) and Feasibility of Intervention Measure (FIM) at baseline, 4 months, and 12 months. Therapist adoption was assessed through training records and self-report. Patient reach was derived from attendance-tracking and hospital-admission data. Results AIM and FIM scores remained high across all time points (AIM 4.4–4.8; FIM 4.6–4.8). Adoption increased over time: therapists trained to lead MTMI rose from 11% to 61%, and self-reported MTMI use increased from 63% to 92%. The mean monthly patient reach was 39%. Conclusions and Relevance Multimodal implementation strategies supported high acceptability, feasibility, and clinician adoption of MTMI in inpatient rehabilitation. Patient reach remained modest. What This Article Adds This study provides practical, context-specific guidance for integrating MTMI into inpatient rehabilitation.