JMIR Publications

ABSTRACT

Background:

Complex regional pain syndrome (CRPS) is a chronic, debilitating condition involving sensory, motor, and neuroplastic dysfunctions. Although movement representation therapies, such as mirror therapy, are recommended for CRPS patients, there is limited evidence for augmented reality mirror therapy (ARMT), particularly within personalized rehabilitation programs.This study aimed to evaluate the efficacy of ARMT as an adjunct to conventional, multidisciplinary rehabilitation programs for adult patients with upper limb CRPS. The primary outcome was hand dexterity. Secondary outcomes included motor imagery, CRPS severity, quality of life, pain intensity, proprioception, and global impression of change.

Objective:

This study aimed to evaluate the efficacy of ARMT as an adjunct to conventional, multidisciplinary rehabilitation programs for adult patients with upper limb CRPS. The primary outcome was hand dexterity. Secondary outcomes included motor imagery, CRPS severity, quality of life, pain intensity, proprioception, and global impression of change.

Methods:

A single-case experimental design (SCED) with an A-B-A multiple baseline design was conducted with six participants. Patients underwent a 10-week outpatient rehabilitation program consisting of three phases: Phase A (conventional therapy), Phase B (conventional therapy + ARMT), and Phase A’ (withdrawal of ARMT). Assessments were performed 20 times per patient (twice weekly). The primary outcome was hand dexterity, which was measured using the Box and Block Test (BBT). Secondary outcomes included mental motor chronometry, CRPS severity score, EuroQol-5D (EQ-5D), patient global impression of change, Rivermead assessment of somatosensory performance (proprioception), and pain intensity (visual analog scale [VAS]). Statistical analyses included Kendall’s tau and tau-U for individual data and mixed linear regression models for group-level data.

Results:

Six patients completed the study (96% of the expected number of assessment sessions). At the group level, adding ARMT to conventional rehabilitation produced a statistically significant improvement in hand function (+3.5 blocks/min, 95% CI: 1.2–5.9; p < 0.001), though this improvement was below the minimal clinically important difference (MCID) of 5.5–6.46 blocks/min. The CRPS Severity Score improved modestly throughout the program (p = 0.02), yet no clinically significant group-level changes were observed in motor imagery, quality of life, pain intensity, proprioception, or global impression of change. High individual variability was observed, with some patients experiencing worsened outcomes. No adverse events were reported.

Conclusions:

Adding ARMT to conventional rehabilitation produced statistically significant, yet clinically modest, improvements in hand function with no meaningful effects on other outcomes. The high variability in responses underscores the heterogeneous nature of CRPS and suggests that personalized rehabilitation programs must evolve beyond considering pain intensity alone. Future trials should prioritize predefined repetitive movement protocols, graded pain exposure, and the incorporation of body perception disturbance assessments to better target neuroplastic mechanisms and improve clinical efficacy. Given its safety and tolerability, ARMT warrants further investigation with optimized, mechanism-driven protocols to improve CRPS outcomes. Clinical Trial: NCT05787119