The Dose Effectiveness of Extracorporeal Shockwave on Plantar Flexor Spasticity of Ankle in Stroke Patients: a Randomized Controlled Trial

Wen-Shiang Chen, Shu-Mei Yang, You-Lin Lu, Chueh-Hung Wu, Meng-Ting Lin, Yen-Hua Chen
Purpose:

The aim of this study was to investigate the dose-response effectiveness of focused ESWT on ankle plantar flexor spasticity in stroke patients.

Methods:

This was a double-blinded randomized controlled trial. Stroke patients diagnosed with PSS in the ankle plantar flexor muscles were eligible for inclusion and randomly assigned to two groups. Patients in the experimental (double-dose ESWT) group received focused shockwave on the spastic calf muscles (4000 pulses per session), while those in the control ESWT group received half the dose on the spastic calf muscle (2000 pulses per session). Both groups underwent a total of four sessions, twice a week for two consecutive weeks. The outcomes, including modified Ashworth Scale (MAS), modified Tardieu Scale (MTS), passive ROM of the ankle, Timed Up and Go (TUG) Test, Barthel index and strain elastography of the plantar flexor muscles, were evaluated at baseline, 1, 4, 12, and 24 weeks after ESWT.

Results:

A total of 39 participants were included in the study. The within-group analysis revealed significant improvements in the MAS, PROM, TUG Test, and Barthel index for double-dose ESWT group, while the control ESWT group showed improvement only in the Barthel index. A between-group analysis demonstrated that the double-dose ESWT group exhibited greater improvements in the TUG Test at all follow-up time points, in the Barthel Index at the week 24, and in the strain elastography at the week 1, compared to the control ESWT group. Generalized estimating equations analysis indicated that the double-dose ESWT group achieved superior outcomes in the TUG Test, Barthel Index, and strain elastography across various time points and groups. No minor or severe complications were reported in either group during the study.

Conclusion(s):

Double-dose ESWT showed better functional improvement and elastography compared to the control group. ESWT demonstrated dose-response effectiveness for PSS of ankle-equinus in stroke patients.

Implications:

This study explores the dose-dependent effects of ESWT on ankle plantar flexor spasticity in post-stroke patients, establishing that higher doses lead to greater functional improvements. It provides crucial insights that can guide more effective dosing protocols for future treatment strategies.

Funding acknowledgements:
The research was funded by National Taiwan University Hospital (NTUH 113-O0025, 113-N0010) and National Taiwan University Hsin-Chu Branch (113-BIH030).
Keywords:
Extracorporeal shockwave therapy
stroke
spasticity
Primary topic:
Neurology: stroke
Second topic:
Disability and rehabilitation
Did this work require ethics approval?:
Yes
Name the institution and ethics committee that approved your work:
The National Taiwan University Hospital Hsin-chu Branch Ethics Committee(s) approved this study.
Provide the ethics approval number:
111-044-F
Has any of this material been/due to be published or presented at another national or international conference prior to the World Physiotherapy Congress 2025?:
No

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