The "Mirror Effect Plus Protocol" for acute Bell's palsy: A randomized controlled trial with 1-year follow-up.

The study analysed 40 participants after eight were lost or excluded, so the sample was small. The quality-of-life questionnaire was added after the study started, so not every participant completed it. The MEPP group had two more participants with House-Brackmann 2.0 grade 4 at baseline, and grade 4 patients are more likely to recover completely. The Sunnybrook global score did not differ between groups, and the authors noted this could reflect limited statistical power and high variance. The study was registered retrospectively because it began as a pilot and was later expanded. Facial symmetry was rated by human judges, not by an objective instrumental measure.

The authors declared doctoral training and research scholar support from Fonds de Recherche du Québec – Santé. Funding came from Réseau Provincial de Recherche en Adaptation-Réadaptation and Fonds de Recherche du Québec – Santé grants.

Do not conclude that mirror therapy alone caused the improvement. The MEPP group also received motor imagery, soft-tissue manipulation, mime therapy, neuromuscular retraining and motor learning principles, on top of medication and counselling, so the contribution of any single component cannot be separated.