Effectiveness of mirror and robot-assisted therapy for upper extremity rehabilitation in post-stroke patients: a meta-analysis

INTRODUCTION: Stroke is a leading cause of death and disability, with survivors often facing upper extremity (UE) impairments. Mirror therapy (MT) can enhance motor function but is influenced by cognitive and emotional factors. Robot-assisted therapy (RT) has shown efficacy in restoring UE function. Robot-mirror therapy (RMT), which combines MT and RT, has been investigated in several trials, with some showing benefits while others reported limited effects. This meta-analysis aimed to evaluate RMT's effectiveness in improving UE function in stroke patients. METHODS: We included RCTs involving RMT in adult stroke patients. Searches covered ten databases (Cochrane Library, Scopus, PubMed, Web of Science, Embase, CNKI, CINAHL, PEDro, ClinicalTrials.gov, WHO ICTRP) through October 2025, with a grey literature search. Two independent reviewers conducted study selection, data extraction, and quality assessment. The risk of bias and the certainty of the evidence were assessed using the Cochrane collaboration's tool and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) guideline, respectively. RESULTS: Sixteen RCTs (n=736) were analyzed. RMT significantly improved UE motor function (Fugl-Meyer Assessment-Upper Extremity (FMA-UE); MD 7.52, 95% CI 4.16-10.87; P