Table 2.
Characteristics of studies using shock waves for the treatment of triceps spasticity after stroke.
| Author | Sample | Intervention and dosage | Comparator | Outcomes |
Follow-up (months) |
Within group difference (over time) |
Between group difference after treatment |
|---|---|---|---|---|---|---|---|
| Lee et al. (27) (RCT) | 18(9/9 IG/CG) patients with spasticity for at least 3 months (MAS > 1) | ESWT (2,000 shots, 0.1 mJ/mm2) in the medial gastrocnemius + physical therapy One single session |
CG: Sham stimulation + physical therapy | MAS pROM, FMA, Achilles Tendon Length (ATL), Fascicle Length (FL), Muscle Thickness (MT), Pennation Angle (PA) |
1 | IG: MAS, pROM ↔
FMA, FL ↑ ATL, MT, PA ↓ CG: MAS, pROM, ATL, MT, PA, FL ↔ FMA ↑ |
ATL, FL, MT, PA† |
| Radinmehr et al. (28) (RCT) | 32 (16/16 IG1/IG2) patients with chronic spasticity (MMAS > 1) | IG1: rSWT (2,000 shots, 0.34 mJ/mm2) in the gastrocnemius One single session |
IG2: Ultrasound therapy | MMAS aROM, pROM, TUG, H-reflex latency, PPFT |
n.a. | IG1: MMAS, TUG, PPFT ↓
AROM, pROM, H-reflex latency ↑ IG2: MMAS, TUG, PPFT ↓ AROM, pROM, H-reflex latency ↑ |
No statistical difference |
| Wu et al. (29) (RCT) | 32 (16/16 IG1/IG2) patients with spasticity for at least 6 months (MAS > 1) | IG1: rSWT (1,500 shots, 0.1 mJ/mm2) in the gastrocnemius and in the soleus Once a week, for 3 weeks |
IG2: fSWT (1,500 shots, 2.0 bar) in the gastrocnemius and in the soleus | MAS, Tardieu Angle pROM, 10 MWT, Dynamic Foot Contact Area (DFCA) |
2 | IG1: MAS, Tardieu Angle ↓
PROM, DFCA ↑ 10MWT ↔ IG2: MAS, Tardieu Angle ↓ pROM, DFCA, DFCA, 10MWT ↔ |
PROM, DFCA† |
| Sawan et al. (30) | 40 (20/20 IG/CG) patients with chronic spasticity (MAS > 1) | ESWT (1,500 shots) in the gastrocnemius + physical therapy Once a week, for 6 weeks |
CG: Sham stimulation + physical therapy | H/M ratio aROM, 10 MWT |
n.a. | IG: H/M ratio, 10 MWT ↓
aROM ↑ CG: H/M ratio, 10 MWT ↓ aROM ↑ |
H/M ratio, aROM† |
| Taheri et al. (31) (RCT) | 25 (13/12 IG/CG) patients with spasticity from 1 month (MAS > 1) | fSWT (1,500 shots, 0.1 mJ/mm2) in the gastrocnemius + stretching exercises Once a week, for 3 weeks |
CG: Stretching exercises | MAS VAS, pROM, Clonus Score (CS), 3 MWT, LEFS |
3 | IG: MAS, VAS ↓
pROM, LEFS ↑ CS, 3 MWT ↔ CG: MAS, VAS, pROM, LEFS, CS ↔ 3 MWT ↓ |
MAS, pROM, LEFS† |
| Radinmehr et al. (32) | 12 patients with spasticity from at least 1 month (MAS > 1) |
rSWT (2,000 shots, 0.34 mJ/mm2) in the gastrocnemius One single session |
n.a. | MMAS aROM, pROM, TUG, H-reflex, H/M ratio, PPFT |
n.a. | MMAS, PPFT, TUG ↓
aROM, pROM, H-reflex ↑ H/M ratio ↔ |
n.a. |
| Santamato et al. (33) | 23 patients with spasticity for at least 5 months (MAS > 1) | fSWT (1,500 shots, 0.1 mJ/mm2) in the gastrocnemius and in the soleus One single session |
n.a. | MAS pROM, Tibial Nerve Conduction (TNC), F-wave latency |
1 | MAS ↓
pROM ↑ (but maintained at 1 month only in patients with Heckmatt 1–3) TNC, F-wave latency ↔ |
n.a. |
| Moon et al. (34) | 30 patients with spasticity for at least 1 month (MAS > 1) | One sham fSWT session physical therapy + fSWT (1,500 shots, 0.089 mJ/mm2) in the gastrocnemius Once a week, for 3 weeks |
n.a. | MAS Clonus Score (CS), pROM, FMA, Peak Eccentric Torque (PET), Torque Threshold Angles (TTAs) |
1 | MAS, PET ↓
TTAs ↑ (But non-significant at follow-up at 1 month) CS, pROM, FMA ↔ |
n.a. |
| Sohn et al. (35) | 10 patients with spasticity for at least 15 months (MAS > 1) | fSWT (1,500 shots, 0.1 mJ/mm2) in the gastrocnemius One single session |
CG: 10 healthy subjects who underwent the same treatment | MAS F-waves latency, H-reflex latency, H/M ratio, Tibial Nerve Conduction (TNC) |
n.a. | IG: MAS ↓
F-wave latency, H-reflex latency, H/M ratio, TNC ↔ CG: MAS not assessed F-wave latency, H-reflex latency, H/M ratio, TNC ↔ |
n.a. |
Statistically significant increase.
Statistically significant decrease.
No statistical difference.
IG overcomes comparator.
IG, Intervention Group; CG, Control Group; n.a. not available; RCT, Randomized Controlled Trial; MAS, Modified Ashworth Scale; ESWT, External Shock-Wave Therapy; aROM, active Range of Motion; FMA, Fugl-Meyer Assessment; ATL, Achilles Tendon Length; FL, Fascicle Length; MT, Muscle Thickness; PA, Pennation Angle; rSWT, radial Shock-Wave Therapy; MMAS, Modified Modified Ashworth Scale; pROM, passive Range of Motion; TUG, Timed Up and Go test; PPFT, Passive Plantarflexor Torque; fSWT, focused Shock-Wave Therapy; 10MWT 10-meter Walking Test; DFCA, Dynamic Foot Contact Area; VAS, Visual Analog Scale; CS, Clonus Score; 3MWT, 3-meter Walking Test; LEFS, Lower Extremity Functional Score; TNC, Tibial Nerve Conduction; PET, Peak Eccentric Torque; TTAs, Torque Threshold Angles.