Efectos de la Terapia en Espejo vs. Ejercicio Terapéutico Cognoscitivo en la mejora de las funciones del miembro superior en pacientes con ictus

Abstract

There are five scientific articles that make up the present doctoral thesis, entitled "Effects of Mirror Therapy vs. Cognitive Therapeutic Exercise on Improving Upper Limb Functions in Stroke Patients," which follows the compilation of publications modality. The rehabilitation of post-stroke patients represents a significant challenge in current medical care, given the complexity of the neurological sequelae that affect individuals' functionality and quality of life (QoL). In this context, research on advances in post-stroke rehabilitation has focused on several crucial aspects to improve clinical outcomes. As a primary aspect, comparative effectiveness research has been conducted on Mirror Therapy (MT) vs. Cognitive Therapeutic Exercise (CTE), combined with Task-Oriented Therapy (TOT), in improving functionality, motor skills, autonomy, and QoL in post-stroke patients. Another important point to consider is evaluation, as it is essential to understand the psychometric characteristics of assessment instruments. Some of these, such as the ARAT and MAL-30, are specifically designed to assess stroke patients, so it is crucial to ensure their validity and reliability in the Spanish population. Furthermore, the relationship between different demographic and clinical variables with functionality and QoL one month after stroke has been investigated, providing crucial data for personalized treatment adaptation. In order to study new advances in post-stroke rehabilitation, a longitudinal study was conducted to test the effectiveness of combining these therapies. Within this longitudinal study, a cross-sectional design was used to analyze data at a specific point in the process to determine the psychometric properties of the scales and identify the characteristics and determining factors of functional independence and QoL in these patients. Our findings suggest that both techniques, Mirror Therapy (MT) and Cognitive Therapeutic Exercise (CTE) combined with Task-Oriented Therapy (TOT), have been effective in improving overall functionality and motor skills of the upper limb, autonomy level, and QoL of stroke patients. Furthermore, none of them has demonstrated greater benefits. Moreover, the assessment instruments ARAT and MAL-30 used in the research provide a scientific and rigorous tool, with adequate validity and reliability for measuring functionality, quantity, and quality of upper limb use in post-stroke patients in the Spanish population. Lastly, a statistically significant relationship has been found between motor function and cognitive ability of patients regarding their functional independence and QoL. This thesis offers a significant contribution to the field of post-stroke rehabilitation by providing results on the effectiveness of evidence-based interventions to maximize outcomes and improve the QoL of stroke-affected patients. Additionally, it provides information about the psychometric properties of specific instruments, emphasizing the need for culturally validated tools. It also delves into the understanding of underlying factors influencing post-stroke functional recovery and QoL. All of these contribute to a more personalized, adapted, and individualized approach in the rehabilitation of these patients.