Dose-response effectiveness of focused shockwave therapy on ultrasonographic muscular properties in patients with stroke exhibiting ankle spasticity.

This is a post hoc secondary analysis, not the primary report of the trial. There were no healthy controls, so the ultrasonographic values cannot be compared with typical muscle architecture. The sample was small and heterogeneous, with adults of different ages and stroke durations, and findings are limited to post-stroke ankle spasticity. About 15% of participants were lost to follow-up at weeks 12 and 24, and missing data were not imputed. All participants also received conventional rehabilitation and some used ankle-foot orthoses or anti-spastic drugs, so the effect of shockwave alone cannot be isolated. One assessor performed all ultrasound measurements, which could introduce measurement bias. No neurophysiological tests were done, so neural mechanisms cannot be assessed.

Funding came from National Taiwan University Hospital Hsin-Chu Branch and National Science and Technology Council. The supplied text does not list author conflicts of interest.

Do not conclude that 4000 shockwave pulses caused better walking, ankle range, or spasticity measures. The between-group dose comparison was null for muscle architecture, and the correlations were found only within the double-dose group. All participants also received conventional rehabilitation, so the paper cannot separate shockwave from those treatments.