Double dose extracorporeal shockwave may be more effective for plantar flexor spasticity of ankle in stroke patients

1. Double-dose ESWT to the gastrocnemius and soleus showed greater improvements in post-stroke ankle plantar flexor spasticity

Evidence Rating Level: 1 (Excellent)

Spasticity is a frequent complication following a stroke, resulting from upper motor neuron syndrome. It presents as an increase in muscle tone that depends on movement speed, caused by heightened excitability of muscle spindles. Extracorporeal shockwave therapy (ESWT) has recently emerged as a treatment modality for post-stroke spasticity (PSS). ESWT s a series of high-energy mechanical waves that promote neovascularization, enhances blood circulation, facilitates cellular self-repair, and can be analgesic by disrupting pain signal transmission. This double-blinded, randomized controlled trial focused on ESWT in post-stroke ankle plantar flexor spasticity to characterize the duration of its effect. Participants were either given double-dose shockwave or a control shockwave protocol. The double-dose ESWT group received 2000 shots for each muscle (gastrocnemius and soleus; 4000 total). The control ESWT group received focused ESWT only to the gastrocnemius muscle (2000 total). Participants were followed for 24 weeks and assessed using the modified Ashworth Scale (MAS) Tardieu Scale (MTS), passive range of motion (PROM) of the ankle, Timed Up and Go (TUG) Test, Barthel index and strain elastography. Double ESWT therapy showed a significant improvement from baseline over 24 weeks (p = 0.043) whereas single ESWT showed no significant improvement (p = 0.128). Similarly, PROM improvement from baseline to 24 weeks was seen in the double ESWT group (p = 0.007) but not in single ESWT (p = 0.181). TUG showed the same trend with double ESWT showing improvements over 24 weeks (p < 0.001) but not single ESWT (p = 0.114). Both groups however showed improvements in the Barthel index. Comparing between groups at different time periods, the TUG test (p = 0.011), Barthel index (p = 0.036), and strain elastography (p = 0.008) showed significant interactions indicating changes in these outcomes over time were different between the groups. Therefore, double-dose ESWT on post-stroke ankle plantar flexor spasticity showed significant improvements compared to the control. 

Click to read the study in BMC Medicine

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