AIM: To determine the efficacy of mirror therapy in children with hemiparesis. METHOD: The design was an observer-blinded parallel-group randomized controlled trial (International Standard Randomised Controlled Trial Number 48748291). Randomization was computer-generated, 1:1 allocation to mirror therapy or comparison groups. The settings were home-based intervention and tertiary centre assessments. Participants were 90 children with hemiparesis aged 7 to 17 years. Intervention was 15 minutes per day of simultaneous arm training, 5 days a week, for 5 weeks. The mirror therapy group used a mirror; those in the comparison group looked at their paretic limb. Assessments comprised measures of upper limb strength, function (Melbourne Assessment 2), daily performance (ABILHand-Kids), and sensory function at weeks 0 (T0), 5 (T1), and 10 (T2). RESULTS: There were no significant differences in outcomes and their progression over time between the mirror therapy and comparison groups. Post-hoc intention-to-treat analyses showed significant improvements in both groups for grasp strength (T0 to T1 +12.6%), pinch strength (T0 to T2 +9.1%), upper limb function in terms of accuracy (T0 to T2 +2.7%) and fluency (T0 to T2 +5.0%), as well as daily performance (T0 to T2 +16.6%). Per protocol analyses showed additional improvements in dexterity (T0 to T2 +4.0%). INTERPRETATION: The use of the mirror illusion during therapy had no significant effect on treatment outcomes. However, 5 weeks of daily simultaneous arm training significantly improved paretic upper limb strength, function, and daily use.

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