The Effectiveness of Mental Practice Interventions on Psychological Health in Stroke Patients: A Systematic Review

Motor impairments after stroke can lead to limitations in functional performance and mental health. Previous systematic reviews and meta-analyses have mainly assessed randomized clinical trials of mental practice interventions (MPI) among stroke patients, focusing on physical outcomes. However, mentally rehearsing a motor movement might increase a patient's self-confidence within the recovery process and thus also lead to positive effects on psychological outcomes. Therefore, we aim to investigate the effectiveness of MPI on psychological health outcomes. We performed a systematic review of RCTs according to PRISMA guidelines. 16.125 records were identified through PubMed, Web of Science, Science Direct, and Cochrane resulting in 8.573 documents after duplicates were removed. After excluding 8.507 documents during title and abstract screening, 64 could be full-text screened. All clinical and randomized controlled trials designed to investigate the effects of mental practice on psychological health in adult patients after stroke were considered eligible. Six studies met the eligibility criteria and were included in the qualitative analysis. The six included studies partly showed positive effects of MPI on psychological health such as quality of life, stroke-specific quality of life, fall-related self-efficacy, positive and negative affect but not on anxiety and depression. Overall, the methodological power is lacking. The included studies differ substantially regarding study design, sample size, intervention protocol and psychological health operationalization. The results show inconsistent effects of MPI on psychological health. More systematic research is needed to investigate the effects of MPI on psychological health and give several recommendations for future research.