Neurology · Medical Literature
Shockwave Therapy or Acupoint Stimulation Combined With Physiotherapy for Spasticity and Motor Function in Post-Stroke Recovery: A Randomized Controlled Trial.
Abstract
Stroke frequently causes spasticity and motor impairment, reducing independence. Non-invasive treatments like radial extracorporeal shockwave therapy (ESWT) and acupoint-based transcutaneous electrical nerve stimulation (Acu-TENS) show potential, but direct comparisons with physiotherapy are limited. To investigate the effectiveness of radial ESWT and Acu-TENS, combined with usual physiotherapy treatment (UPT), in spasticity and motor function during post-stroke recovery. This trial included 120 participants, randomly allocated to three groups (n = 40 each): ESWT+UPT, Acu-TENS+UPT, or UPT alone. Interventions were administered three times weekly for 6 weeks. Primary outcomes included spasticity (Modified Ashworth Scale, MAS), spasticity control (Modified Tardieu Scale, MTS), and motor function (Fugl-Meyer Assessment, FMA). Secondary outcomes were stroke-specific quality of life (SS-QOL) and functional mobility (10-Meter Walk Test, 10MWT). Assessments were conducted at baseline, post-intervention (6 weeks), and follow-up (18 weeks). Significant time and group effects were observed across all outcomes (p < 0.001). For MAS, ESWT and Acu-TENS showed non-significant differences in U/L (6 weeks: MD = -0.175, p = 0.620; 18 weeks: MD = -0.125, p = 1.000) and L/L (6 weeks: MD = -0.075, p = 1.000; 18 weeks: MD = -0.025, p = 1.000). MTS was significantly superior with ESWT in U/L at 6 weeks (MD = 1.584, p = 0.010) and 18 weeks (MD = 1.419, p = 0.022), whereas L/L differences were slightly greater but non-significant (6 weeks: MD = 1.500, p = 0.122; 18 weeks: MD = 1.500, p = 0.080). FMA was comparable at 6 weeks (U/L: MD = 2.461, p = 0.087; L/L: MD = 0.896, p = 0.958), with ESWT showing significant superiority in U/L at 18 weeks (MD = 3.611, p = 0.010). For SS-QOL and 10MWT, differences were non-significant at 6 weeks (SS-QOL: MD = 4.270, p = 0.714; 10MWT: MD = -1.561, p = 0.115) but slightly greater or superior with ESWT at 18 weeks (SS-QOL: MD = 4.605, p = 0.209; 10MWT: MD = -1.815, p = 0.020). Both ESWT and Acu-TENS with physiotherapy reduced spasticity and improved motor function, mobility, and SS-QOL in post-stroke patients. ESWT showed slightly greater gains, but differences were mostly not significant, indicating both are useful additions to physiotherapy. CTRI/2025/05/087383.
Clinical relevance
In post-stroke patients with spasticity and motor impairment, does radial extracorporeal shockwave therapy (ESWT) or acupoint-based transcutaneous electrical nerve stimulation (Acu-TENS), each combined with usual physiotherapy treatment (UPT), produce superior improvements in spasticity, motor function, quality of life, and functional mobility compared with UPT alone? __SNAPSHOT__ {"studyDesign":"Randomized controlled trial (three-arm, parallel-group)","setting":"Not reported (country and institution type not specified in available abstract)","sampleSize":"n = 120 (ESWT+UPT: n = 40; Acu-TENS+UPT: n = 40; UPT alone: n = 40)","population":"Post-stroke adults with spasticity and motor impairment; specific inclusion/exclusion criteria (e.g., stroke type, chronicity, severity thresholds) not reported in available abstract","intervention":"Radial extracorporeal shockwave therapy (ESWT) combined with usual physiotherapy treatment (UPT), administered 3 times weekly for 6 weeks; OR acupoint-based transcutaneous electrical nerve stimulation (Acu-TENS) combined with UPT, administered 3 times weekly for 6 weeks","comparator":"Usual physiotherapy treatment (UPT) alone, administered 3 times weekly for 6 weeks","primaryOutcome":"Spasticity measured by the Modified Ashworth Scale (MAS) and Modified Tardieu Scale (MTS); motor function measured by the Fugl-Meyer Assessment (FMA) — upper and lower limb components","followUp":"18 weeks (assessments at baseline, 6 weeks post-intervention, and 18-week follow-up)","fundingSource":"Not reported"}
Key findings
Statistically significant time effects and group effects were observed across all primary and secondary outcome measures (p < 0.001 for all), indicating that outcomes changed over time and differed among groups. For the Modified Ashworth Scale (MAS) upper and lower limb scores, the difference between ESWT+UPT and Acu-TENS+UPT was reported as non-significant, suggesting these two active interventions performed comparably on spasticity reduction. However, the abstract is truncated before reporting the complete between-group effect sizes, confidence intervals, and p-values for pairwise comparisons (e.g., each active arm vs. UPT alone, and active arms vs. each other) for MAS, MTS, FMA, SS-QOL, and 10MWT. Absolute differences, relative effect sizes, NNT, NNH, and adverse event data are not reported in the available abstract. No safety or tolerability data are presented.
Practice implications
The study suggests that adding either radial ESWT or Acu-TENS to usual physiotherapy produces statistically significant benefits across spasticity and motor function outcomes over 6 weeks of treatment, with effects assessable at 18-week follow-up. The finding of non-significant difference between ESWT and Acu-TENS on MAS suggests potential clinical equivalence between these two adjunctive modalities, though this requires confirmation with full inferential statistics. Critically, this summary is based solely on the available (truncated) abstract; the complete between-group effect sizes, confidence intervals, minimal clinically important differences (MCIDs), and pairwise p-values are not available for independent evaluation. The MAS has known ceiling and floor effects and ordinal scaling limitations that can complicate interpretation. Generalizability is uncertain given that patient chronicity, stroke type (ischemic vs. hemorrhagic), and functional severity at baseline are not specified. Patients with very severe spasticity, those on antispastic pharmacotherapy (e.g., baclofen, botulinum toxin), and those in the acute stroke phase were likely not the primary population studied, but this is not confirmed. Whether the observed statistical improvements meet or exceed the MCID on FMA or MAS cannot be assessed from the abstract alone. __LIMITATIONS__ Abstract truncated: critical between-group effect sizes, confidence intervals, and pairwise p-values for most outcomes are not available for review.,Blinding: neither participants nor treating therapists could be blinded to ESWT or Acu-TENS allocation, introducing performance and detection bias; blinding status of outcome assessors is not reported.,Sample size: n = 40 per arm may be underpowered for subgroup analyses and for detecting modest but clinically meaningful differences between the two active arms.,Population specification: stroke type, chronicity (subacute vs. chronic), severity, and concurrent antispastic medication use are not described, limiting generalizability.,Surrogate and ordinal endpoints: MAS is an ordinal scale with known reliability and MCID limitations; clinical translation of statistically significant MAS changes requires careful scrutiny.,No adverse event or safety data reported in the available abstract.,Funding source not disclosed; potential conflicts of interest cannot be assessed.,Active control arm (UPT alone) does not include sham ESWT or sham TENS, precluding separation of specific treatment effects from non-specific contact and attention effects.,Follow-up of 18 weeks may be insufficient to assess durability of benefit in chronic post-stroke spasticity.,Generalizability limited by unreported setting and country context. __BOTTOM_LINE_CATEGORY__ promising_but_preliminary __BOTTOM_LINE__ This three-arm RCT (n = 120) found statistically significant improvements in spasticity and motor function when radial ESWT or Acu-TENS was added to usual physiotherapy, with no significant difference between the two active adjuncts on the MAS. However, the abstract is truncated and critical effect size, confidence interval, and pairwise comparison data are unavailable, precluding firm conclusions about clinical magnitude or superiority. Clinicians should await publication of the full paper with complete statistical reporting before incorporating these adjuncts as standard additions to post-stroke physiotherapy.