Radial extracorporeal shock wave therapy in patients with spasticity after stroke based on randomized clinical trials: a systematic review and meta-analysis, and trial sequential analysis
In brief
Radial shock wave therapy cuts spasticity scores by about two points for up to three months
A meta-analysis of 25 randomized trials found that radial extracorporeal shock wave therapy lowered Modified Ashworth Scale scores by roughly two points immediately after treatment and maintained similar improvements through 12 weeks, with the greatest gains in the upper limb. Benefits were seen across ethnic groups, but larger studies are needed to confirm durability and safety.
- Journal
- Folia neuropathologica (Q2)
- Published
- 1 January 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Yi Liu, Ran Ma, Jing Mao, Na Liu
- PMID
- 42704859
- DOI
- 10.5114/fn.2026.161801
Why clinicians should know about it
- Picked for Pathology and Forensic Medicine (top studies of the week, 13 September 2026).
Abstract
INTRODUCTION: Extracorporeal shock wave therapy (ESWT) was first used to treat kidney stones with lithotripsy. The present meta-analysis aims to evaluate radial ESWT (rESWT) in patients with spasticity after stroke in randomized controlled trials (RCTs) comparing the timing of Modified Ashworth Scale (MAS) measurement as a primary outcome in these patients. MATERIAL AND METHODS: A comprehensive literature search was conducted across multiple databases, such as PubMed/Medline, Web of Science, Scopus, and Cochrane Library, until January 16, 2024, without any limitations to find relevant RCTs. The Review Manager 5.3 software was used to compute the effect sizes, which were expressed as the standardized mean difference (SMD) along with a 95% confidence interval (CI). A total of 25 RCT articles were included in the meta-analysis. The estimate of effect size showed statistically significant MAS grade reduction immediately after treatment, 1 week after, 2 weeks after, 3 weeks after, 4 weeks after, 6 weeks after, 8 weeks after, and 12 weeks after. RESULTS: Twenty-five RCTs were entered into the meta-analysis. The pooled SMDs of MAS score for spasticity in post-stroke patients before compared to after rESWT were as follows: 1.82 (95% CI: 1.32, 2.32, p < 0.00001) immediately after, 1.25 (95% CI: 0.85, 1.66, p < 0.00001) one week after, 2.30 (95% CI: 1.07, 3.53, p = 0.0002) after two weeks, 1.19 (95% CI: 0.88, 1.49, p < 0.00001) after four weeks, 1.21 (95% CI: 0.88, 1.54, p < 0.00001) after eight weeks, and 1.83 (95% CI: 1.94, 2.73, p < 0.0001) twelve weeks after rESWT. CONCLUSIONS: The research revealed that rESWT was associated with a notable decrease in the MAS score in patients who had suffered a stroke at all observed time points. Both upper and lower limbs showed significant improvement, especially in the upper limb. All ethnic groups, particularly Arabs, showed significant improvement in MAS scores after treatment.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.