Effect of Radial Shock Wave Therapy on Spasticity of the Upper Limb in Patients With Chronic Stroke: A Prospective, Randomized, Single Blind, Controlled Trial

Abstract

Recently, studies have reported that extracorporeal shock wave therapy (ESWT) is a safe, noninvasive, alternative treatment for spasticity. However, the effect of ESWT on spasticity cannot be determined, because most studies to date have enrolled small patient numbers and have lacked placebo-controlled groups and/or long-term follow-up. In addition, whether varying the number of ESWT sessions would affect the duration of the therapeutic effect has not been investigated in a single study. Hence, we performed a prospective, randomized, single blind, placebo-controlled study to investigate the long-term effect of radial ESWT (rESWT) in patients with poststroke spasticity and surveyed the outcome of functional activity.Sixty patients were randomized into 3 groups. Group A patients received 1 session of rESWT per week for 3 consecutive weeks; group B patients received a single session of rESWT; group C patients received one session of sham rESWT per week for 3 consecutive weeks. The primary outcome was Modified Ashworth Scale of hand and wrist, whereas the secondary outcomes were Fugl-Meyer Assessment of hand function and wrist control. Evaluations were performed before the first rESWT treatment and immediately 1, 4, 8, 12, and 16 weeks after the last session of rESWT.Compared to the control group, the significant reduction in spasticity of hand and wrist lasted at least 16 and 8 weeks in group A and B, respectively. Three sessions of rESWT had a longer-lasting effect than one session. Furthermore, the reduction in spasticity after 3 sessions of rESWT may be beneficial for hand function and wrist control and the effect was maintained for 16 and 12 weeks, respectively.rESWT may be valuable in decreasing spasticity of the hand and wrist with accompanying enhancement of wrist control and hand function in chronic stroke patients.

Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

FIGURE 1

Timeline of treatment session with data collection in 3 groups. Group A patients received 1 session of radial extracorporeal shock wave therapy (rESWT) per week for 3 consecutive weeks; group B patients received a single session of rESWT; group C patients received 1 session of sham rESWT per week for 3 consecutive weeks. Evaluations were performed before the 1st rESWT treatment and immediately 1, 4, 8, 12, and 16 weeks after the last session of rESWT in each group (except hand function and wrist control immediately after rESWT).

FIGURE 2

CONSORT flow diagram.

FIGURE 3

Mean of change from baseline in MAS in all groups (mean ± standard error). (A) MAS of hand: group B had significant improvement compared with group C until week 12. The differences between group A and group B reach significant at most of the observed time-points (except week 1 and week 4). (B) MAS of wrist: group B had significant improvement compared with group C until week 8. The differences between group A and group B reach significant at most of the observed time-points (except week 1). (∗P < 0.05, ∗∗P < 0.01, and ∗∗∗P < 0.001 mean group A vs B; +P < 0.05, ++P < 0.01, and +++P < 0.001 mean group B vs C. One-way ANOVA followed by the Bonferroni post hoc tests was used). ANOVA = analysis of variance, MAS = Modified Ashworth Scale.

FIGURE 4

Mean of change from baseline in FMA in all groups (mean ± standard error). (A) FMA of hand function: group A had significant improvement compared with group B and C at all observed time-points. (B) FMA of wrist control: the difference in group A was significantly larger than those of group C until week 8 and those of group B until week 12. (∗P < 0.05, ∗∗P < 0.01, and ∗∗∗P < 0.001 mean group A vs B; +++P < 0.001 mean group A vs C. One-way ANOVA followed by the Bonferroni post hoc tests was used). ANOVA = analysis of variance, FAS = Fugl-Meyer Assessment.