Effectiveness of radial Extracorporeal Shock Wave Therapy in Reduces muscle spasms in Stroke Patients; A Systematic Review and Meta-Analysis

Objectives: Effectiveness of radial extracorporeal shock wave therapy (rESWT) on pain, range of motion and muscle tone in patients with stroke injuries. Methods: PubMed, EMBASE, Cochrane Library and VIP information were used to collect information for research conducted between the beginning of 2013 and the end of 2022. These studies were randomized controlled trials that used rESWT for muscle spasm in stroke patients with conventional treatments as controls. There are no specific restrictions on the duration of treatment, the type of reESWT, or the severity of symptoms. These studies must have assessed at least one of the following outcome mesurements: visual analog scale (VAS) for pain, Ashwerth measure for muscle tone or external rotation range of motion (ER ROM). RevMan 5.3 software was used to check the quality of included studies. For continuous variables, mean difference (MD) or standardized MD (SMD) with CI 95% were derived. For dichotomous data, event proportions and sample sizes were extracted. Results: In the conducted investigations, it was found that 7 studies investigated the effectiveness of rESWT  treatments after the intervention in comparison with conventional treatment in terms of reducing pain intensity. In total, all 7 studies showed that the rESWT intervention was effective in reducing pain intensity compared to conventional treatments (MD, –0.97 [95% CI, –2.13 to –0.42], P < .00001, I2 = 71%). Compared with traditional treatments, the effectiveness of rESWT plus routine treatments on muscle tone after intervention was assessed in terms of Ashwerth critrion  in 4 trials (SMD, 1.13 [95% CI, 0.46-1.23], P < .00001, I2 =  59%). ER ROM was used to reflect the ROM, which was assessed in 4 RCTs. Because of the limited number of studies, ER ROM was measured immediately after treatment in all included studies. The pooled result of the included studies showed that the heterogeneity was high and unacceptable (MD, 10.31 [95% CI, 2.47–16.18], P < .003, I2 = 81%). Conclusion: The results of this research indicated that rESWT treatment can be used as a safe and non-invasive method to quickly reduce spasticity and increase joint range of motion in stroke patients. But more research on the long-term effects of rESWT as well as the factors influencing its effectiveness to reduce spasticity and comparison with other new treatment protocols is suggested.