EFFECTS OF EXTRACORPOREAL SHOCK WAVE THERAPY ON SPASTICITY IN POST-STROKE PATIENTS: A SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS

Objective: To evaluate whether extracorporeal shock wave therapy significantly improves spasticity in post-stroke patients. Design: Systematic review and meta-analysis. Data sources: PubMed, EMBASE, EBSCO, Web of Science, Cochrane CENTRAL electronic databases. Study selection: Randomized controlled trials assessing the effect of extracorporeal shock wave therapy on post-stroke patients with spasticity were selected for inclusion. Data extraction: Two authors independently screened the literature, extracted data, and assessed the quality of included studies. Primary outcome was modified Ashworth scale (MAS). Secondary outcomes were Modified Tardieu Scale (MTS), H/M ratio and range of motion. Data synthesis: Eight randomized controlled trial studies (n = 385 patients) were included in the meta-analysis. There was a high level of evidence that extracorporeal shock wave therapy significantly ameliorates spasticity in post-stroke patients according to the 4 parameters: MAS (standard mean difference (SMD) -1.22; 95% confidence interval (95% CI): -1.77 to -0.66); MTS (SMD 0.70; 95% CI 0.42-0.99,); H/M ratio (weighted mean difference (WMD) -0.76; 95% CI -1.19 to -0.33); range of motion (SMD 0.69; 95% CI 0.06-1.32). However, there was no statically significant difference on the MAS at 4 weeks (SMD -1.73; 95% CI -3.99 to 0.54). Conclusion: Extracorporeal shock wave therapy has a significant effect on spasticity in post-stroke patients.