Long-Term Efficacy of Extracorporeal Shock Wave Therapy on Lower Limb Post-Stroke Spasticity: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Emanuela Elena Mihai; Luminita Dumitru; Ilie Valentin Mihai; Mihai Berteanu

doi:10.3390/jcm10010086

Long-Term Efficacy of Extracorporeal Shock Wave Therapy on Lower Limb Post-Stroke Spasticity: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

J Clin Med. 2020 Dec 29;10(1):86. doi: 10.3390/jcm10010086.

Authors

Emanuela Elena Mihai¹, Luminita Dumitru^{1

2}, Ilie Valentin Mihai^{3

4}, Mihai Berteanu^{1

2}

Affiliations

¹ Physical and Rehabilitation Medicine Department, Carol Davila University of Medicine and Pharmacy Bucharest, 050451 Bucharest, Romania.
² Physical and Rehabilitation Medicine Department, Elias University Emergency Hospital, 011461 Bucharest, Romania.
³ Doctoral School of Electronics, University Politehnica of Bucharest, 060042 Bucharest, Romania.
⁴ Institute of Electronics and Telecommunications of Rennes, University of Rennes 1, 35000 Rennes, France.

Abstract

The purpose of this systematic review and meta-analysis is to evaluate the long-term efficacy of Extracorporeal Shock Wave Therapy (ESWT) on reducing lower limb post-stroke spasticity in adults. A systematic electronic search of PubMed/ MEDLINE, Physiotherapy Evidence Database (PEDro), Scopus, Ovid MEDLINE(R), and search engine of Google Scholar was performed. Publications that ranged from January 2010 to August 2020, published in English, French, Spanish, Portuguese, and Italian language and available as full texts were eligible for inclusion and they were searched without any restrictions of country. The study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines and followed the recommendations of the Cochrane Handbook for Systematic Reviews of Interventions. Two authors screened the references, extracted data, and assessed the risk of bias. The primary outcome was spasticity grade mainly assessed by the Modified Ashworth Scale (MAS). Secondary outcomes were passive range of motion (PROM), pain intensity, electrophysiological parameters, gait assessment, and adverse events. A total of seven recent randomized controlled trials (RCTs) were included in the systematic review and meta-analysis, and a beneficial effect on spasticity was found. The high level of evidence presented in this paper showed that ESWT ameliorates spasticity considering the parameters: MAS: standardized mean difference (SMD) = 0.53; 95% confidence interval (95% CI): (0.07-0.99); Modified Tardieu Scale (MTS): SMD = 0.56; 95% CI: (0.01-1.12); Visual Analogue Scale (VAS): SMD = 0.35; 95% CI: (-0.21-0.91); PROM: SMD = 0.69; 95% CI: (0.20-1.19). ESWT presented long-term efficacy on lower limb post-stroke spasticity, reduced pain intensity, and increased range of motion. The effect of this novel and non-invasive therapy was significant and the intervention did not present adverse events, proving a satisfactory safety profile.

Keywords: extracorporeal shock wave therapy; hemiplegia; neurological rehabilitation; spasticity; stroke.

Publication types

Review