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FOTO Rehab Outcomes Blog

Mirror Therapy for Individuals who have Shoulder Pain

It's difficult to truly know the value of a single session without knowing whether the single session findings were maintained or changed  the next session. It's also difficult to know the value of a single intervention without knowing the full package of interventions provided for the full episode of care. 

As I sit and think a bit more, what would happen if there were 3 groups: 1) mirror group using unaffected upper extremity, 2) no mirror group using unaffected upper extremity and 3) no mirror group using affected upper extremity.  

I can appreciate the investigators were reasonable in sharing statistical AND clinical significance. What does confuse me just a tad is that mirror therapy is also something that is part of a home exercise program. How much change is expected after brief session of mirror therapy in the clinic? There is also the importance of education. What was the educational component of the session? I mean, patients had to have been wondering, "what the heck? It's my other shoulder that hurts." Maybe I need the full text to see if my questions are answered in the article.

Below you will find a quick view of the abstract. 



Single-blind case series


Three outpatient physical therapy clinics


Patients with shoulder pain and limited AROM.


Patients moved their unaffected shoulder through comfortable AROM in front of a mirror so that it appeared that they were moving their affected shoulder.

Main Outcome Measure(s)

We measured pain, pain catastrophization, fear-avoidance and AROM in 69 consecutive patients with shoulder pain and limited AROM before and immediately after mirror therapy.


There were significant differences in self-reported pain (p=.014), Pain Catastrophization (p<.001), and the Tampa Scale of Kinesiophobia (p=.012) immediately after mirror therapy, although the means did not meet or exceed the minimal detectable change (MDC) for each outcome measure. There was a significant increase (mean = 14.5°) in affected shoulder flexion AROM immediately post-mirror therapy (p<0.001), which exceeded the MDC of 8 degrees.


A brief mirror therapy intervention can result in statistically significant improvements in pain, pain catastrophization, fear-avoidance and shoulder flexion AROM in patients presenting with shoulder pain with limited AROM. The immediate changes may allow a quicker transition to multimodal treatment, including manual therapy and exercise in these patients. Further studies, including randomized controlled trials, are needed to investigate these findings and determine longer term effects.

DOI: http://dx.doi.org/10.1016/j.apmr.2017.03.031