Radial extracorporeal shock wave therapy may be effective for upper limb spasticity

1. Patients with chronic upper limb spasticity post-stroke randomized to radial extracorporeal shock wave therapy (rESWT) had greater symptomatic and functional improvement than patients randomized to transcutaneous electrical nerve stimulation (TENS). 

Evidence Rating Level: 1 (Excellent)

It is estimated that 43% of patients who survive a stroke experience upper limb spasticity, which can be functionally impairing. Transcutaneous electrical nerve stimulation (TENS) has been the standard treatment for this, while radial extracorporeal shock wave therapy (rESWT) has also been shown to treat spasticity. This single-centre randomized controlled trial based in Sri Lanka aimed to compare the efficacy of rESWT and TENS for treating patients with chronic upper limb spasticity post-stroke. Participants included must have had their first stroke 6 months prior to enrollment, resulting in hemiplegia. The treatments were administered one session a week for four weeks, with follow-up assessments after the first and last sessions. The outcomes measured included: Spasticity as defined on the 4-point modified Ashworth scale, voluntary control grading (VCG), and hand function as defined through the Fugl-Meyer Assessment of Upper Limb (FMA-UL). In total, there were 106 patients randomized equally to rESWT and TENS. Both cohorts demonstrated decreased spasticity, but the difference was greater in the rESWT group compared to TENS, with a 4.8 times (95% CI 1.956-2.195) reduction in spasticity after 4 weeks. VCG and FMA-UL scores also improved in both, but moreso in the rESWT patients, with 3.9 times (95% CI 2.314-2.667) improvement in VCG and 3.8 times (95% CI 19.549-22.602) improvement in FMA-UL hand function score. Overall, this study showed that both rESWT and TENS are effective treatments for chronic upper limb spasticity post-stroke, with rESWT potentially being a superior modality.

Click to read the study in PLOS ONE

Image: PD

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