Effects of Extracorporeal Shockwave Therapy in Chronic Stroke Patients With Knee Osteoarthritis: A Pilot Study

Abstract

ObjectiveTo evaluate the effects of extracorporeal shockwave therapy (ESWT) on pain, function, and ultrasonographic features of chronic stroke patients with knee osteoarthritis (OA).MethodsA total of 18 chronic stroke patients (33 knee joints) with unilateral or bilateral knee OA (Kellgren-Lawrence grade ≥1) were enrolled in this study. The patients were randomly allocated to an experimental group receiving ESWT (n=9) or a control group receiving sham ESWT (n=9). For the ESWT group, patients received 1,000 pulses weekly for 3 weeks, totaling to an energy dose of 0.05 mJ/mm2 on the proximal medial tibia of the affected knee. The assessments were performed before the treatment, immediately after the first treatment, and 1 week after the last treatment using the following: the visual analog scale (VAS) for pain; patient perception of the clinical severity of OA; the Korean version of Modified Barthel Index (ambulation and chair/bed transfer); the Functional Independence Measure scale (FIM; bed/chair/wheelchair transfer, toilet transfer, walking, and stairs); and ultrasonographic features (articular cartilage thickness, Doppler activity, and joint effusion height).ResultsThe experimental group showed a significant improvement in VAS score (4.50±1.87 to 2.71±1.38) and patient perception of the clinical severity of OA (1.87±0.83 to 2.75±0.46). The bed/chair/wheelchair transfer components of the FIM score also improved significantly (4.12±1.55 to 4.62±1.30). In terms of the ultrasonographic features, increased Doppler activity was observed in the medial knee in the experimental group immediately following ESWT.ConclusionIt is suggested that ESWT may reduce pain and improve function in chronic stroke patients with OA, and may increase vascular activity at the target site.

Extracorporeal Shock Wave Therapy for the Treatment of Osteoarthritis: A Systematic Review and Meta-Analysis

“…The sample size ranged from 18 to 160. All experimental groups received ESWT, while control groups received different treatments including placebo [22,23,25,26,28,30,34,48,49,51,52], medication [31,32,43,44,50], intra-articular injections [21,26,27,29,35,36,39,40], traditional Chinese medicine [38,41,42,45,2 BioMed Research International 46], ultrasound [22,24,47], surgery [33], and kinesiotherapy (KIN) [37].…”

Effect of Extracorporeal Shockwave Therapy Versus Intra-articular Injections of Hyaluronic Acid for the Treatment of Knee Osteoarthritis

“…These reports reveal that the application of ESWT to the arthritic joint of animals delayed the OA progression, improved motor dysfunction, reduced pain, and observed a regression of OA and chondroprotective effects [ 9 10 11 12 ]. Some recent studies elucidated that ESWT has an effect on pain relief and improvement of knee functions when applied to human subjects [ 13 14 15 ]. Considering these study results, ESWT can be a beneficial option for knee OA treatment.…”

Sonographic soft tissue arthritic changes associated with post-stroke hemiplegic knee pain: utility of musculoskeletal ultrasound in a resource-limited setting

“…A prospective, double-blind, randomised, controlled trial by Cho et al [9] evaluated the effects of weekly extracorporeal shockwave therapy (ESWT) on some sonographic arthritic changes of 18 chronic stroke patients over a three-week period. Although they reported a statistically significant increased Doppler activity (increased blood flow) in the medial knee joint in the experimental group, there was no statistically significant change in femoral articular cartilage thickness and joint effusion height.…”

“…Most of the published studies comparing arthritic differences between hemiplegic and non-hemiplegic limbs of stroke patients are based on the structural changes in the joints and soft tissues of the upper limb. Only a few researchers have studied sonographic arthritic changes in the knee joints of stroke patients [3,[7][8][9][10]. Also, to the best of the authors' knowledge, none of the studies published in English literature has described structural sonographic determinant of knee joint pain in stroke patients.…”