Work

Adjunctive extracorporeal shock wave therapy after botulinum toxin type A injection for post-stroke spasticity: a systematic review and three-level meta-analysis

Year: 2026

Type: review

Study designs: Systematic Review, Meta-Analysis

Abstract: Background Post-stroke spasticity is a common rehabilitation problem, and botulinum toxin type A (BTX-A) is a standard focal treatment. Whether extracorporeal shock wave therapy (ESWT) provides clinically relevant additional benefit after BTX-A remains uncertain. Objective This systematic review and three-level meta-analysis evaluated the add-on effect of ESWT after BTX-A for post-stroke spasticity, with particular attention to impairment-level and activities-of-daily-living outcomes. Methods: PubMed, Embase, Cochrane Library, Web of Science, CNKI, Wanfang Data, VIP, and CBM were searched from inception to March 2026. Randomized controlled trials of BTX-A plus ESWT in adult post-stroke spasticity were included. The primary quantitative synthesis was restricted to BTX-A-based comparators. Hedges' g was pooled with three-level random-effects models to account for dependent effect sizes. Results Seven randomized controlled trials with 377 participants met the qualitative criteria, and six trials with 242 participants contributed to the primary quantitative synthesis. Adjunctive ESWT was associated with greater reduction in Modified Ashworth Scale scores ( g = 0.87, 95% CI 0.41 to 1.34; p < 0.001) and greater improvement in Fugl-Meyer Assessment scores ( g = 1.11, 95% CI 0.45 to 1.76; p < 0.001). Activities-of-daily-living estimates favored the combined intervention but did not reach conventional statistical significance ( g = 1.15, 95% CI −0.03 to 2.32; p = 0.056). Two participants developed transient erythema after ESWT, but adverse-event reporting was too incomplete for a comparative safety estimate. Conclusion Adjunctive ESWT may improve short-term impairment-level outcomes after BTX-A, but certainty is limited and evidence for reliable functional independence gains is very uncertain. Modality-, target-, timing-, and dose-specific findings remain exploratory. Systematic Review Registration Identifier INPLASY202630010; https://doi.org/10.37766/inplasy2026.3.0010 .

Source: Frontiers in Neurology

DOI: 10.3389/fneur.2026.1890975

Authors: Weihao Ke, Lujiang Wang, Wenli Shen, Min Chen, Zhenyu Wang

Institution: Chongqing Medical University

Language: English

Topic: Botulinum Toxin and Related Neurological Disorders

Subfield: Clinical Neurology

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $3,801