Posts Tagged extracorporeal shock wave therapy
[Abstract] The effectiveness of extracorporeal shock wave therapy to reduce lower limb spasticity in stroke patients: a systematic review and meta-analysis
Objective: To assess the effectiveness of Extracorporeal Shock Wave Therapy (ESWT) to reduce lower limb spasticity in adult stroke survivors.
Data Sources: A systematic review of Medline/Pubmed, CENTRAL, CINAHL, PEDro database, REHABDATA, Scielo, Scopus, Web of Science, Trip Database, and Epistemonikos from 1980 to December 2018 was carried out.
Review Methods: The bibliography was screened to identify clinical trials (controlled and before-after) that used ESWT to reduce spasticity in stroke survivors. Two reviewers independently screened references, selected relevant studies, extracted data, and assessed risk of bias by PEDro scale. The primary outcome was spasticity.
Results: A total of 12 studies (278 participants) were included (5 randomized controlled trials, 1 controlled trial, and 6 before-after studies). A meta-analysis was performed by randomized controlled trials. A beneficial effect on spasticity was found. The mean difference (MD) was 0.58; 95% confidence interval (CI) 0.30 to 0.86 and also in subgroup analysis (short, medium, and long term). The MD for range of motion was 1.81; CI −0.20 to 3.82 and for lower limb function the standard mean difference (SMD) was 0.34; 95% CI −0.09 to 0.77. Sensitivity analysis demonstrated a better beneficial effect for myotendinous junction. MD was 1.5; 95% CI −2.44 to 5.44 at long-term (9 weeks).
Conclusion: The ESWT (radial/focused) would be a good non-invasive rehabilitation strategy in chronic stroke survivors to reduce lower limb spasticity, increase ankle range of motion, and improve lower limb function. It does not show any adverse events and it is a safe and effective method.
[ARTICLE] Effect of Radial Shock Wave Therapy on Spasticity of the Upper Limb in Patients With Chronic Stroke: A Prospective, Randomized, Single Blind, Controlled Trial – Full Text
Sixty patients were randomized into 3 groups. Group A patients received 1 session of rESWT per week for 3 consecutive weeks; group B patients received a single session of rESWT; group C patients received one session of sham rESWT per week for 3 consecutive weeks. The primary outcome was Modified Ashworth Scale of hand and wrist, whereas the secondary outcomes were Fugl-Meyer Assessment of hand function and wrist control. Evaluations were performed before the first rESWT treatment and immediately 1, 4, 8, 12, and 16 weeks after the last session of rESWT.
Compared to the control group, the significant reduction in spasticity of hand and wrist lasted at least 16 and 8 weeks in group A and B, respectively. Three sessions of rESWT had a longer-lasting effect than one session. Furthermore, the reduction in spasticity after 3 sessions of rESWT may be beneficial for hand function and wrist control and the effect was maintained for 16 and 12 weeks, respectively.
rESWT may be valuable in decreasing spasticity of the hand and wrist with accompanying enhancement of wrist control and hand function in chronic stroke patients.
Extracorporeal shock wave therapy (ESWT) is defined as a sequence of acoustic pulses characterized by high peak pressure (100 MPa), fast pressure rise (<10 ns), short duration (10 μs), and an energy density ranging from 0.003 to 0.890 mJ/mm.1 Different studies and clinical experiments have demonstrated the efficacy of ESWT in the treatment of musculoskeletal disorders such as chronic tendinopathies, calcific tendinitis of the shoulder, lateral epicondylitis, and plantar fasciitis, etc.1 The side effects of ESWT including aching, tingling, redness, or bruising are relatively rare and transitory.1
Radial ESWT (rESWT), a type of pneumatically generated shock wave, has a low to medium energy compared with traditional focused ESWT (fESWT). These unforced shock waves disperse eccentrically from the applicator tip without focusing the energy to a targeted spot. The penetrative depth is therefore less than that of fESWT (up to 3 vs 12 cm).2 A recent systematic review and meta-analysis reported potential advantages of rESWT over fESWT in patients with plantar fasciitis because rESWT has a larger treatment area, specific focusing is less important, it does not require additional local anesthesia, and it is cheaper.2
Spasticity is a common complication in patients with stroke and is defined as a velocity-dependent enhancement in muscle tone in response to passive stretching because of supraspinal disinhibition of stretch reflexes. The prevalence of spasticity is reported as 39% in patients with 1st-ever stroke after 12 months.3 The constant contraction of spastic muscles can produce pain, declined mobility, contractures, and skeletal deformities, which may limit the potential effect of rehabilitation.4 Common management of spasticity consists of passive stretching, splints, drug, phenol injection, and botulinum toxin (BTX) injection. However, current treatments of spasticity in poststroke survivors are often unsatisfactory.5
In recent years, studies have reported that ESWT is a safe, noninvasive, alternative treatment for spasticity that does not cause muscle weakness or unpleasant effects in patients with stroke,6–15cerebral palsy,16–19 and multiple sclerosis.20 Although a recent small meta-analysis (including only 5 studies) reported that ESWT had a significant effect on improving spasticity 4 weeks after treatment compared with baseline in patients with brain injury,21 the effect of ESWT on spasticity cannot be determined because most studies to date have enrolled small patient numbers, and have lacked placebo-controlled groups and/or long-term follow-up. Among these studies, only 3 have included a placebo-controlled group in patients with cerebral palsy,17 stroke,7 and multiple sclerosis.20 To the best of our knowledge, only 1 study, without a control group, has applied rESWT for spasticity of the upper extremity in stroke patients.14Whether varying the number of ESWT sessions would affect the duration of the therapeutic effect has not been investigated in a single study. Moreover, the general improvement in functional disability after reduction of spasticity via ESWT application to the upper limb has rarely been investigated in previous studies.
Hence, we performed a prospective, randomized, single blind, placebo-controlled study to investigate the long-term effect of rESWT in patients with poststroke spasticity and surveyed the outcome of functional activity.