Effects of extracorporeal shock wave therapy on spasticity in post-stroke patients: A systematic review and meta-analysis of randomized controlled trials

To evaluate whether extracorporeal shock wave therapy significantly improves spasticity in post-stroke patients. Systematic review and meta-analysis. PubMed, EMBASE, EBSCO, Web of Science, Cochrane CENTRAL electronic databases. Randomized controlled trials assessing the effect of extracorporeal shock wave therapy on post-stroke patients with spasticity were selected for inclusion. 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. 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). Extracorporeal shock wave therapy has a significant effect on spasticity in post-stroke patients.