Radial extracorporeal shock wave therapy improves upper limb function in chronic stroke patients: a randomized sham-controlled trial.

CONTEXT: Stroke causes upper limb disability. The literature shows the effectiveness of radial Extracorporeal Shock Wave Therapy (rESWT) in reducing spasticity and promoting functional recovery of the upper limb of patients with stroke.

OBJECTIVE

Demonstrate the effect of rESWT on functional recovery of the upper extremity after ischemic stroke in the middle cerebral artery territory.

METHODS

Randomized, doubleblind, sham-controlled trial.

INTERVENTIONS: Weekly sessions of 5,000 rESWs (3.5 to 4.0 bar, 15 Hz), diffusely over the elbow and wrist flexors in the forearm and hand interosseous muscles for four weeks, delivered with a 36 mm device. A control treatment was conducted by a sham handpiece that did not emit the rESWs.

OUTCOMES: Changes in Fugl-Meyer Assessment for upper limb function (FMA-UE) at four weeks after the end of the treatment was the primary outcome. Spasticity, strength, and cortical integrity by transcranial magnetic stimulation were also assessed before and four weeks after the end of the treatment .

RESULTS

23 patients were randomized, and 16 were included in the per-protocol analysis. Baseline measures were were balanced. FMA-UE was significantly different between the groups for proximal muscles (p = 0.004) and overall score (p = 0.038). Muscle strength by the Medical Research Council (MRC) score was also significantly different between both groups (p = 0.012). Three patients of the rESWT group and four patients of the sham rESWT group were excluded due to the use of Botulinum toxin, declined participation soon after they were randomized, or did not return four weeks after the end of treatment to follow-up. A limitation of this study is its small sample size, which limits the statistical power and the generalizability of our findings.

CONCLUSION

Four weekly sessions of rESWT improved the functional recovery of patients with chronic ischemic stroke and absent MEPs at baseline. This suggests rESWT may act via peripheral mechanisms to improve proximal muscle function, reflected in the overall improvement of the global measure of FMA-UE.