Duration of Treatment Effect of Extracorporeal Shock Wave on Spasticity and Subgroup-Analysis According to Number of Shocks and Application Site: A Meta-Analysis

Objective To investigate duration of the treatment effect of extracorporeal shockwave therapy (ESWT) on spasticity levels measured with Modified Ashworth Scale (MAS) regardless of the patient group (stroke, multiple sclerosis, and cerebral palsy) and evaluate its spasticity-reducing effect depending on the number of shocks and site of application. Methods PubMed, EMBASE, the Cochrane Library, and Scopus were searched from database inception to February 2018. Randomized controlled trials and cross-over trials were included. All participants had spasticity regardless of cause. ESWT was the main intervention and MAS score was the primary outcome. Among 122 screened articles, 9 trials met the inclusion criteria. Results The estimate of effect size showed statistically significant MAS grade reduction immediately after treatment (standardized mean difference [SMD]=-0.57; 95% confidence interval [CI], -1.00 to -0.13; p=0.012), 1 week after (SMD=-1.81; 95% CI, -3.07 to -0.55; p=0.005), 4 weeks after (SMD=-2.35; 95% CI, -3.66 to -1.05; p<0.001), and 12 weeks after (SMD=-1.07; 95% CI, -2.04 to -0.10; p=0.03). Meta-regression and subgroup analysis were performed for the 'immediately after ESWT application' group. The prediction equation obtained from meta-regression was -1.0824+0.0002* (number of shocks), which was not statistically significant. Difference in MAS grade reduction depending on site of application was not statistically significant either in subgroup analysis (knee and ankle joints vs. elbow, wrist, and finger joints). Conclusion ESWT effectively reduced spasticity levels measured with MAS regardless of patient group. Its effect maintained for 12 weeks. The number of shocks or site of application had no significant influence on the therapeutic effect of ESWT in reducing spasticity. Ongoing trials with ESWT are needed to address optimal parameters of shock wave to reduce spasticity regarding intensity, frequency, and numbers.