The effectiveness of extracorporeal shock wave therapy for improving upper limb spasticity and functionality in stroke patients: a systematic review and meta-analysis

Abstract

Objective: To assess the effectiveness of Extracorporeal Shock Wave Therapy for reducing spasticity and improving functionality of the upper limb in stroke survivors. Data sources: A systematic review of MEDLINE, Cochrane Central Register of Controlled Trials, CINAHL, PEDro, REHABDATA, Scielo, Scopus, Web of Science, Tripdatabase and Epistemonikos from 1980 to April 2020 was carried out. Review methods: The bibliography was screened to identify randomized controlled clinical trials that applied extracorporeal shock waves to upper limb spastic muscles in post-stroke individuals. Two reviewers independently screened references, selected relevant studies, extracted data and assessed risk of bias using the PEDro scale. The primary outcome was spasticity and functionality of the upper limb. Results: A total of 1,103 studies were identified and 16 randomized controlled trials were finally included (764 individuals) were analyzed. A meta-analysis was performed and a beneficial effect on spasticity was found. The mean difference (MD) on the Modified Ashworth Scale for comparison extracorporeal shock wave versus sham was −0.28; with a 95% confidence interval (CI) from −0.54 to −0.03. The MD of the comparison of extracorporeal shock wave plus conventional physiotherapy versus conventional physiotherapy was −1.78; 95% CI from −2.02 to −1.53. The MD for upper limb motor-function using the Fugl Meyer Assessment was 0.94; 95% CI from 0.42 to 1.47 in the short term and 0.97; 95% CI from 0.19 to 1.74 in the medium term. Conclusion: The extracorporeal shock wave therapy is effective for reducing upper limb spasticity. Adding it to conventional therapy provides an additional benefit.

Optimal Method of Electrical Stimulation for the Treatment of Upper Limb Dysfunction After Stroke: A Systematic Review and Bayesian Network Meta-Analysis of Randomized Controlled Trials

“…At present, in the Rehabilitation Treatment (RT) of stroke patients with hemiplegia, various rehabilitation techniques based on the concepts and theories of Bobath, Rood, Brunnstrom and Proprioceptive Neuromuscular Facilitation (PNF) are the primary rehabilitation training methods. Recently, an increasing number of novel treatments have been applied to the rehabilitation of stroke patients with upper limb motor dysfunction, including Virtual Reality (VR), 5 Brain-machine Interface (BI), 6 Mental Practice (MP), 7 extracorporeal shock wave therapy, 8 music therapy 9,10 and so on. However, the effect of these novel treatments in clinical practice has not been fully verified.…”

Effects of Radial Extracorporeal Shock Wave Therapy on Flexor Spasticity of the Upper Limb in Post-stroke Patients: Study Protocol for a Randomized Controlled Trial

“…Clinical studies ( 48 – 50 ) have shown that ESWT may improve the muscle spasm of stroke patients without serious adverse reactions. A meta-analysis ( 51 ) found that adding the ESWT to conventional therapy provides an additional benefit for reducing upper limb spasticity, and the results may be optimal given the ESWT at the subacute phase, but the mechanism remains unclear. Many studies conducted in recent years have been investigating the biological effects of ESWT ( 52 – 55 ).…”

Comparative Effectiveness of Botulinum Toxin Injections and Extracorporeal Shockwave Therapy for Post-Stroke Spasticity: A Systematic Review and Network Meta-Analysis

“…14−16 A recent meta-analysis reviewed 16 randomized controlled trials (RCTs) of stroke patients, and reported that ESWT was effective in reducing upper-limb spasticity for more than 12 weeks. 17 Another meta-analysis demonstrated that the beneficial effects of ESWT in alleviating lower-limb spasticity could last for more than four weeks. 18 Compared with BoNT injections, ESWT is a non-drug therapy and does not elicit neuromuscular denervation.…”