Efficacy of extracorporeal shock wave therapy for post-stroke spasticity and dose-response analysis: a meta-analysis of randomized controlled trials
Journal
European Journal of Physical and Rehabilitation Medicine
Journal Volume
61
Journal Issue
6
ISSN
1973-9087
1973-9095
Date Issued
2026-02
Author(s)
Abstract
Post-stroke spasticity (PSS) is a common complication affecting motor function and quality of life in stroke patients. Extracorporeal shockwave therapy (ESWT) has been proposed as a non-invasive treatment for PSS, though variations in protocols raise questions about its efficacy and optimal dosage. This review aims to evaluate the efficacy of ESWT in reducing PSS and analyze its dose-response relationship. A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted. Adults with spasticity following ischemic or hemorrhagic stroke in rehabilitation or hospital-based clinical settings were included. RCTs assessing ESWT versus sham or no intervention were selected, with spasticity reduction measured by the Modified Ashworth Scale (MAS) as the primary outcome. Secondary outcomes included range-of-motion (ROM), functionality, and the Modified Tardieu Scale, assessed in both the short and long term. Risk of bias was evaluated using the revised Cochrane Risk of Bias Tool. Meta-analyses and meta-regression were performed using R software. Thirteen RCTs with 533 participants were included. Meta-analyses demonstrated that ESWT significantly reduced MAS scores in the short term [mean difference (MD)=-0.85; 95% confidence interval (CI): -1.17 to -0.53, P<0.01] and long term (MD=-0.84; 95% CI: -1.31 to -0.38, P<0.01). Secondary outcomes also improved in both short-term (P<0.01) and long-term analyses (P=0.04). Meta-regression revealed a dose-response relationship for the primary outcome, showing that higher ESWT doses were associated with greater MAS improvement. ESWT effectively reduces PSS with short- and long-term benefits. A dose-response relationship suggests higher doses provide better outcomes. However, further research is needed to optimize treatment protocols due to the observed heterogeneity.
Publisher
Edizioni Minerva Medica
Type
journal article