Shock Waves as a Treatment Modality for Spasticity Reduction and Recovery Improvement in Post-Stroke Adults - Current Evidence and Qualitative Systematic Review

Purpose: This systematic review examines intervention studies using extracorporeal shock wave therapy (ESWT) application in post-stroke muscle spasticity with particular emphasis on the comparison of two different types of radial (rESWT) and focused shock waves (fESWT). Methods: PubMed, PEDro, Scopus, and EBSCOhost databases were systematically searched. Studies published between the years 2000 and 2019 in the impact factor journals and available in the English full-text version were eligible for inclusion. All qualified articles were classified in terms of their scientific reliability and methodological quality using the PEDro criteria. The PRISMA guidelines were followed and the registration on the PROSPERO database was done. Results: A total of 17 articles were reviewed of a total sample of 303 patients (age: 57.87 +/- 10.45 years and duration of stroke: 40.49 +/- 25.63 months) who were treated with ESWT. Recent data confirm both a subjective (spasticity, pain, and functioning) and objective (range of motion, postural control, muscular endurance, muscle tone, and muscle elasticity) improvements for post-stroke spasticity. The mean difference showing clinical improvement was: Delta=34.45% of grade for fESWT and Delta=34.97% for rESWT that gives a slightly better effect of rESWT (Delta=0.52%) for spasticity (p<0.05), and Delta=38.83% of angular degrees for fESWT and Delta=32.26% for rESWT that determines the more beneficial effect of fESWT (Delta=6.57%) for range of motion (p<0.05), and Delta=18.32% for fESWT and Delta=22.27% for rESWT that gives a slightly better effect of rESWT (Delta=3.95%) for alpha motor neuron excitability (p<0.05). The mean PEDro score was 4.70 +/- 2.5 points for fESWT and 5.71 +/- 2.21 points for rESWT, thus an overall quality of evidence grade of moderate (fair for fESWT and good for rESWT). Three studies in fESWT and four in rESWT obtained Sackett's grading system's highest Level 1 of evidence. Conclusion: The studies affirm the effectiveness of ESWT in reducing muscle spasticity and improving motor recovery after stroke.