Extracorporeal Shock Wave Therapy on Spasticity After Upper Motor Neuron Injury: A Systematic Review and Meta-analysis.

Twenty-two of the 42 trials were rated at high risk of bias and the other 20 raised some concerns, and only six trials described how they kept the treatment assignment hidden, so the pooled result rests on weak studies. The review included only trials published in Chinese or English, so relevant trials in other languages were missed. Because of the nature of the treatment, the people delivering shock wave therapy could not be blinded. The trials disagreed substantially (I² = 77% for the main spasticity outcome), and certainty of evidence was low for that outcome. The Modified Ashworth Scale depends on the assessor's judgement, and many trials did not blind the person assessing the outcome. Several subgroup comparisons rest on a single trial, including multiple sclerosis, spinal cord injury and pressure above 3 bar. Trial sizes ranged from 12 to 96 participants, and nine trials reporting the main outcome could not be pooled at all.

The review does not state who funded it, and the supplied text contains no funding or conflict-of-interest declaration from the authors.

Do not take this as proof that shock wave therapy is an established treatment for spasticity. Twenty-two of the 42 trials were rated at high risk of bias and the rest raised some concerns, and the certainty of evidence for the main outcome was low, so a later and better-conducted trial could change the size of this effect.