Efficacy of extracorporeal shock wave therapy for post-stroke spasticity and dose-response analysis: a meta-analysis of randomized controlled trials.
Shu-Mei Yang, Shao-Yu Chen, Kuan-Yu Chen and 2 others
PMID 41677776WHAT IT FOUND
Extracorporeal shock wave therapy significantly reduced post-stroke spasticity in the short and long term, with a dose-response relationship showing higher total pulses yielded greater muscle tone reduction.
Benefits were clearer for the upper limb, and the treatment was well tolerated.
Key findings
01ESWT significantly reduced spasticity (MAS) in the short term, with a mean difference of -0.85, and this benefit persisted in the long term with a mean difference of -0.84.
02A dose-response relationship was identified: higher total doses of ESWT were associated with greater reductions in Modified Ashworth Scale scores in both the short and long term.
03While short-term improvements in secondary outcomes like function were significant, long-term secondary outcomes showed only a non-significant trend toward improvement.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
There was substantial heterogeneity across the studies (I² > 90% for many analyses), meaning the included trials varied widely in their patient populations and ESWT protocols. Many of the included trials had a high risk of bias regarding the blinding of participants and personnel, which could inflate the perceived effect of the treatment. The analysis combined different types of ESWT (focused and radial) and varied treatment frequencies, making it difficult to recommend a single optimal protocol. The long-term effect on lower limb spasticity was not statistically significant, and secondary functional outcomes showed high variability.
Declared interests
The authors declare no conflicts of interest. The study was funded by the National Science and Technology Council.
The easy way to misread this
Do not assume that reducing spasticity with ESWT will automatically lead to better long-term functional recovery or gait improvement. The study found that while muscle tone decreased significantly, the improvements in secondary functional outcomes were less pronounced in the long term and did not always reach statistical significance.
Summarised by AI from the full paper, without a clinician reviewing it. Check it against the source before it changes what you do. Read it on PubMed →