Shock Waves as a Treatment Modality for Spasticity Reduction and Recovery Improvement in Post-Stroke Adults - Current Evidence and Qualitative Systematic Review

Clin Interv Aging. 2020 Jan 6;15:9-28. doi: 10.2147/CIA.S221032. eCollection 2020.

Abstract

Purpose: This systematic review examines intervention studies using extracorporeal shock wave therapy (ESWT) application in post-stroke muscle spasticity with particular emphasis on the comparison of two different types of radial (rESWT) and focused shock waves (fESWT).

Methods: PubMed, PEDro, Scopus, and EBSCOhost databases were systematically searched. Studies published between the years 2000 and 2019 in the impact factor journals and available in the English full-text version were eligible for inclusion. All qualified articles were classified in terms of their scientific reliability and methodological quality using the PEDro criteria. The PRISMA guidelines were followed and the registration on the PROSPERO database was done.

Results: A total of 17 articles were reviewed of a total sample of 303 patients (age: 57.87±10.45 years and duration of stroke: 40.49±25.63 months) who were treated with ESWT. Recent data confirm both a subjective (spasticity, pain, and functioning) and objective (range of motion, postural control, muscular endurance, muscle tone, and muscle elasticity) improvements for post-stroke spasticity. The mean difference showing clinical improvement was: ∆=34.45% of grade for fESWT and ∆=34.97% for rESWT that gives a slightly better effect of rESWT (∆=0.52%) for spasticity (p<0.05), and ∆=38.83% of angular degrees for fESWT and ∆=32.26% for rESWT that determines the more beneficial effect of fESWT (∆=6.57%) for range of motion (p<0.05), and ∆=18.32% for fESWT and ∆=22.27% for rESWT that gives a slightly better effect of rESWT (∆=3.95%) for alpha motor neuron excitability (p<0.05). The mean PEDro score was 4.70±2.5 points for fESWT and 5.71±2.21 points for rESWT, thus an overall quality of evidence grade of moderate ("fair" for fESWT and "good" for rESWT). Three studies in fESWT and four in rESWT obtained Sackett's grading system's highest Level 1 of evidence.

Conclusion: The studies affirm the effectiveness of ESWT in reducing muscle spasticity and improving motor recovery after stroke.

Keywords: muscle spasticity; neurorehabilitation; older adults; shock waves; stroke; systematic review.

Publication types

  • Systematic Review

MeSH terms

  • Extracorporeal Shockwave Therapy / methods
  • Humans
  • Middle Aged
  • Muscle Spasticity* / etiology
  • Muscle Spasticity* / therapy
  • Recovery of Function
  • Stroke Rehabilitation / methods*
  • Treatment Outcome

Grant support

This review study is theoretical part of the project conducted under a Research Grant for Young Scientists founded by the Ministry of Science and Higher Education of Poland from statutory sources of the Wroclaw Medical University in Poland (no. STM.E025.17.018) and supported by statutory grant of the Wroclaw Medical University in Poland for maintaining research potential (no. SUB.E020.19.003).