Effects of radial extracorporeal shockwave therapy on spasticity of upper-limb agonist/antagonist muscles in patients affected by stroke: a randomized, single-blind clinical trial

Abstract

Background the effects of radial extracorporeal shock wave therapy (rESWT) were assessed on agonist/antagonist muscles in stroke patients with elbow spasticity, the duration of effects and influence on function. Methods patients were randomly assigned into groups: control (A, n = 25), rESWT on agonist muscles (B, n = 27) and rESWT on antagonist muscles (C, n = 30) groups. Conventional physical therapy was given to three groups for 3 weeks, six times a week, and besides, rESWT was given at 4-day intervals for five consecutive treatments, B received rESWT on agonist muscles and C received rESWT on antagonist muscles. The primary outcome was Modified Ashworth Scale (MAS) scores. Modified Tardieu Scale, Visual Analogue Scale (VAS), Fugl-Meyer Assessment and swelling scale (SS) scores were secondary outcomes. Indicators were assessed at baseline, after five treatments and after 4 weeks follow-up. Results the rate of treatment was determined by changes in MAS, which was 16.0 (A), 70.4 (B) and 63.3% (C) after rESWT treatments, and was 24.0 (A), 74.1 (B) and 66.7% (C) after 4 weeks follow-up. Improvements were achieved for R1 (P < 0.01), R2 (P < 0.01) and VAS (P < 0.01) after five rESWT interventions. At 4 weeks, significant improvements were achieved for R1 (P < 0.01) and VAS (P < 0.01). Conclusions rESWT is an effective therapy for spasticity after stroke, with lasting effects on both agonist and antagonist muscles after 4 weeks. rESWT relieved pain but had no effect on active function or swelling of the upper limbs.

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

“…The PRISMA diagram (see Figure 1) summarizes the results of the scientific literature search. Sixteen randomized controlled trials were included: these were by Bae et al, 15 Santamato et al, 16 Fouda et al, 17 Dymarek et al, 18 Kim et al, 19 Li et al, 20 Yoon et al, 21 Duan et al, 22 Guoxing et al, 23 Guo et al, 24 Fouda et al, 25 Kamaluddin et al, 26 Park et al, 27 Wu et al, 28 Ahmed et al, 29 and Li et al 30 Studied identified but not included are shown in Appendix 2. No author responded when contacted for additional information.…”

“…Only one study reported brain area stroke. 28 Most patients were in the chronic phase (>six months) except in the studies by Duan et al, 22 Guoxing et al, 23 Kamaluddin et al 26 which were in the subacute phase, Guo et al, 24 which were in late phase and Li et al 30 included both. All the studies included patients with a Modified Ashworth Scale 31 muscle spasticity score ⩾ 1, and excluded patients with fixed muscle contractures = 4 score points.…”

“…A stroke may result in limitations in reciprocal inhibition and excessive agonist-antagonist co-activation. 45 This symptom could be treated by extracorporeal shock waves on the agonist and antagonist spastic muscles together, as performed by Li et al 30 There is still some controversy regarding the different types of waves. A recent systematic review 46 reported potential advantages of radial extracorporeal shock waves compared to focused extracorporeal shock waves in spastic muscles.…”

“…The targeted muscles were the flexor carpi radialis and ulnaris, interosseous hand muscles, followed by the flexor digitorum superficialis, biceps brachii, supraspinatus and subscapularis. One study 30 also shot at the triceps brachii. As regards the application point, most studies applied extracorporeal shockwave to the muscle belly and myotendinous junction in the same session.…”

“…The passive range of motion was measured in four studies using a goniometer (digital or manually). Only Ahmed et al 29 assessed hand grip strength using a hydraulic hand dynamometer and another study 30 evaluated the degree of wrist swelling based on swelling scale scores. Five studies also evaluated pain intensity using the visual analogue scale.…”