Comparison of the effect of focused and radial extracorporeal shock waves on spastic equinus in patients with stroke: a randomized controlled trial

BACKGROUND: Recent studies have suggested that either focused or radial shock wave therapy is an effect method for the treatment of spasticity in patients with stroke. However, no previous study compared these two types of extracorporeal shock wave on spasticity in patients with stroke. This study aimed to compare the effect of focused and radial shock wave therapy for the treatment of spastic equinus in patients with stroke. DESIGN: Randomized control trial. SETTING: Outpatient rehabilitation center in a medical center. POPULATION: Thirty-two stroke patients with spastic equinus (18 males and 14 women; mean age, 60.1 +/- 10.6 years). METHODS: Patients were randomly assigned to receive three sessions of either focused or radial shock wave therapy at 1-week intervals. The intensities that were used during focused shock wave therapy (0.12 mJ/mm(2)) and radial shock wave therapy (2.4 bar) were comparable. The patients were evaluated at baseline and at 1, 4, and 8 weeks after the final shockwave treatment. The primary outcome measure was change of modified Ashworth Scale Score of gastrocnemius muscle. The secondary outcome measures were Tardieu Scale, ankle passive range of motion, dynamic foot contact area and gait speed. A linear mixed model with repeated measures was used to compare each outcome measure between the two groups. RESULTS: Both groups improved significantly in terms of modified Ashworth Scale Score and Tardieu Scale, and no differences were found between the two groups. In terms of ankle passive range of motion and plantar contact area during gait, the radial shock wave therapy yielded a significantly greater improvement than the focused shock wave therapy. No significant changes were observed in gait speed in either group. CONCLUSIONS: Our study suggested that focused and radial shock wave therapy resulted in similar significant improvements in the modified Ashworth scale score and Tardieu scale. but those in the radial shock wave therapy group experienced greater improvements in the ankle passive range of motion and plantar contact area during gait. CLINICAL REHABILITATION IMPACT: Both focused and radial shock wave therapy yielded similar improve the spasticity of gastrocnemius muscle. Radial shock wave therapy is superior to focused shock wave therapy in terms of improving the ankle passive range of motion and plantar contact area during gait in patients with stroke.