Long-Term Efficacy of Extracorporeal Shock Wave Therapy on Lower Limb Post-Stroke Spasticity: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Abstract

The purpose of this systematic review and meta-analysis is to evaluate the long-term efficacy of Extracorporeal Shock Wave Therapy (ESWT) on reducing lower limb post-stroke spasticity in adults. A systematic electronic search of PubMed/ MEDLINE, Physiotherapy Evidence Database (PEDro), Scopus, Ovid MEDLINE(R), and search engine of Google Scholar was performed. Publications that ranged from January 2010 to August 2020, published in English, French, Spanish, Portuguese, and Italian language and available as full texts were eligible for inclusion and they were searched without any restrictions of country. The study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines and followed the recommendations of the Cochrane Handbook for Systematic Reviews of Interventions. Two authors screened the references, extracted data, and assessed the risk of bias. The primary outcome was spasticity grade mainly assessed by the Modified Ashworth Scale (MAS). Secondary outcomes were passive range of motion (PROM), pain intensity, electrophysiological parameters, gait assessment, and adverse events. A total of seven recent randomized controlled trials (RCTs) were included in the systematic review and meta-analysis, and a beneficial effect on spasticity was found. The high level of evidence presented in this paper showed that ESWT ameliorates spasticity considering the parameters: MAS: standardized mean difference (SMD) = 0.53; 95% confidence interval (95% CI): (0.07–0.99); Modified Tardieu Scale (MTS): SMD = 0.56; 95% CI: (0.01–1.12); Visual Analogue Scale (VAS): SMD = 0.35; 95% CI: (−0.21–0.91); PROM: SMD = 0.69; 95% CI: (0.20–1.19). ESWT presented long-term efficacy on lower limb post-stroke spasticity, reduced pain intensity, and increased range of motion. The effect of this novel and non-invasive therapy was significant and the intervention did not present adverse events, proving a satisfactory safety profile.

Tele-Rehabilitation Strategies for a Patient With Post-stroke Spasticity: A Powerful Tool Amid the COVID-19 Pandemic

“…However, it showed improvement at T2 compared to T0. The clinical improvement of MAS grade showed the effectiveness of the rESWT in the short and long term, and the results are consistent with those from various studies [ 7 - 8 ]. Knee and ankle PROM showed significant improvement after the treatment.…”

“…Knee and ankle PROM showed significant improvement after the treatment. Several studies have already presented satisfying effects of rESWT therapy on post-stroke spasticity [ 7 - 8 ]. Additionally, rESWT also reduced pain intensity and clonus score through its effects on the muscles and tendons, providing long-term tissue regeneration, antalgic and anti-inflammatory properties [ 8 - 9 ].…”

“…Several studies have already presented satisfying effects of rESWT therapy on post-stroke spasticity [ 7 - 8 ]. Additionally, rESWT also reduced pain intensity and clonus score through its effects on the muscles and tendons, providing long-term tissue regeneration, antalgic and anti-inflammatory properties [ 8 - 9 ]. FMA-LE showed sensorimotor and functional improvement in correlation to the stabilometric outcomes.…”

Comparative Analysis of the Effect of Low-Frequency Repeated Transcranial Magnetic Stimulation and Extracorporeal Shock Wave on Improving the Spasm of Flexor after Stroke

“…ESWT applied to the periphery has a positive effect in improving the stiffness of chronic hyperosmolar muscle fibrosis connective tissue, improving the elasticity and stiffness of tendons, improving the tone, stiffness, and elasticity of the biceps muscle in patients with PSS, increasing the passive range of motion of the elbow joint, and promoting the recovery of upper limb motor function [20]. rTMS and ESWT are commonly used clinically to relieve muscle spasm, and the efficacy of both in patients with PSS has been reported and recognized in the literature [21][22][23].…”

Distinctive Gut Microbiota Alteration Is Associated with Poststroke Functional Recovery: Results from a Prospective Cohort Study

“…Stroke has been reported to be the major global health issue with an annual incidence of 258 per 100,000 person-years worldwide [ 1 ]. Patients suffering from stroke impose a heavy medical and economic burden on both society and the family [ 2 ]. With the medical advances in interventions for stroke (e.g., intravenous thrombolysis and endovascular treatment), the survival rate has been significantly improved while the disability rate increases [ 3 ].…”