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Effect and Optimal Timing of Extracorporeal Shock-Wave Intervention to Patients With Spasticity After Stroke: A
Liang-Jun Ou-Yang1, Po-Huang Chen, Cho-Hao Lee
1From the Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Linkou, Taiwan (L-JO-Y, T-YY); Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan (P-HC); Division of Hematology and Oncology Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan (C-HL); Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan (T-YL, Y-TW); Department of Research and Development, School of Medicine, National Defense Medical Center, Taipei, Taiwan (Y-TW); Integrated Pain Management Center, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan (Y-TW); Department of Neurology, Changhua Christian Hospital, Changhua, Taiwan (H-JJ); School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan (H-JJ); and College of Medicine, Chang Gung University, Taoyuan City, Taiwan (T-YY).
Objective:
This study investigated the efficacy of extracorporeal shock wave therapy as well as the optimal intervention timing for extracorporeal shock wave therapy for patients with spasticity after stroke.
Design:
A search of randomized controlled trials was conducted in different electronic databases. We performed a meta-analysis to measure the effect of extracorporeal shock wave therapy versus sham interventions on spasticity and limb functionality. The meta-regression analysis was performed to determine the adequate intervention timing of extracorporeal shock wave therapy. The follow-up period of the outcomes was divided into the short (<2 wks), mid (>2 wks and ≤4 wks), and long (>4 wks and ≤3 mos) terms.
Results:
Thirteen studies with 677 participants were evaluated. Spasticity significantly improved throughout the follow-up duration. Limb functionality significantly improved in the short-term follow-up period. The meta-regression analysis showed that patients with stroke duration less than 45 mos may be benefited from extracorporeal shock wave therapy in improving limb function in all follow-up periods.
Conclusions:
Extracorporeal shock wave therapy is an effective method for reducing spasticity in patients with stroke, and the effect could be maintained for up to 3 mos. Its effects on limb functionality could persist for at least 2 wks. Patients who had stroke for less than 45 mos may have significant benefit from extracorporeal shock wave therapy in all follow-up periods.
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