Extracorporeal shockwave therapy on spasticity after central nervous system injury: A systemic review and meta-analysis

Abstract

Background: Spasticity is a disorder characterized by velocity dependently increasing in the tonic stretch reflexes (muscle tone). There were variable managements for spasticity. Treatment of spasticity depends on the severity, involved part, and patient's and families' preference. However, there were more trials completed in studying the efficacy of extracorporeal shockwave therapy (ESWT) in treating spasticity in different disease. Aim: The goal of our study is to evaluate the efficacy of ESWT in treating of spasticity after central nervous system lesions and to analyze the influences of related factors; we performed a systemic review to survey the effect. Methods: We performed a thoroughly systematic review and meta-analysis. Results: Totally 9 studies were included 4 studies examined the spasticity in stroke group, 4 studies were in cerebral palsy, and 1 study in multiple sclerosis. Regarding the effect of spasticity reduction in overall populations, the pooled effect showed that the modified Ashworth scale grade reduction compared with the baseline values were standardized mean difference (SMD): −4.07 (95% confidence interval (CI), −5.37– −2.76; P < 0.001) immediately after ESWT, SMD: −2.51 (95% CI, −3.40– −1.62; P < 0.001) after 4 weeks, and SMD: −1.44 (95% CI, −1.92– −0.95; P < 0.001) after 12 weeks. In terms of the disease types, the SMD in stroke patients was SMD: −4.03 (95% CI, −5.44– −2.61; Z = 5.57; P < 0.001) immediately after ESWT, SMD: −2.34 (95% CI, −3.01– −1.66; Z = 6.80; P < 0.001) after 4 weeks and SMD: −1.50 (95% CI, −2.06– −0.93; Z = 5.20; P < 0.001) after 12 weeks. No significant adverse events were found. Conclusion: The present meta-analysis revealed that ESWT effectively alleviates spasticity in patients after upper motor neuron lesions, regardless of disease type and parts treated. Both radial and focus ESWTs could decrease spasticity, regardless of the treatment session. The result could last for 12 weeks after treatment. Moreover, no serious side effects were observed after ESWT. Further studies with randomization and more parameters of ESWT were advised to setup to improve the clinical effectiveness.

Keywords

• extracorporeal shock wave therapy
• spasticity
• meta-analysis