INTRODUCTION: Stroke is the leading cause of physical disability in adults in France. Many rehabilitation strategies for stroke have been developed in recent years, such as mirror therapy (MT). The effectiveness of MT for the improvement of upper limb (UL) motor function has been demonstrated. However, there is a disparity between the different protocols used in MT research including two types of MT, unimanual MT (UMT) and bimanual MT (BMT), which are also used in clinical practice. The objective of this work is to determine which type of MT is most effective in improving (1) motor function, (2) motor impairment of the hemiparetic upper limb, and (3) participation in activities of daily living (ADLs) after stroke. METHODS: A systematic review of the literature was conducted by a reviewer. Only randomized controlled studies published between 2012 and 2019 were included. A meta-analysis comparing UMT and BMT with the control groups was carried out, followed by a subgroup analysis (UMT versus BMT) in order to indirectly compare the effectiveness of UMT with BMT. RESULTS: Nineteen studies were included (602 patients). The results show a moderate effect size in favor of UMT (SMD 0.31; 95% CI -0.24 to 0.85; p = 0.27; I2 = 62%), against a small effect size for BMT (SMD 0.05; 95% CI -0.18 to 0.28; p = 0.67; I2 = 12%) when these modalities are compared to the control group. On the other hand, the difference between the subgroups (UMT versus BMT) was not significant (p = 0.39). For motor impairment, the effect size was small for both UMT and BMT (DMS 0.11; 95% CI -0.46 to 0.67; p = 0.71; I2 = 70% versus DMS 0.23; 95% CI 0.05 to 0.42; p = 0.01; I2 0%) compared to the control group. Again the difference between the subgroups was not significant (p = 0.68). Effect size was moderate for UMT (MSD 0.51; 95% CI -0.10 to 1.13; p = 0.10; I2 = 65%) and small for BMT (MSD 0.22; 95% CI -0.09 to 0.53; p = 0.17; I2 = 29%) regarding participation in ADLs. Difference between the UMT and BMT subgroups was not significant (p = 0.40). CONCLUSION: Although this study suggests that UMT may be more beneficial than BMT for improving motor function and participation in ADLs after stroke, data do not allow to assert this. High-powered randomized controlled trials are needed to test this hypothesis.

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