Adjunctive extracorporeal shock wave therapy after botulinum toxin type A injection for post-stroke spasticity: a systematic review and three-level meta-analysis
- 1Department of Critical Care Rehabilitation Medicine, Affiliated Rehabilitation Hospital of Chongqing Medical University
- 2Affiliated Rehabilitation Hospital of Chongqing Medical University
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 .
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BibTeX
@article{ke2026adjunctive,
title = {{Adjunctive extracorporeal shock wave therapy after botulinum toxin type A injection for post-stroke spasticity: a systematic review and three-level meta-analysis}},
author = {Weihao Ke and Lujiang Wang and Wenli Shen and Min Chen and Zhenyu Wang},
journal = {Frontiers in Neurology},
year = {2026},
month = oct,
doi = {10.3389/fneur.2026.1890975},
url = {https://www.frontiersin.org/articles/10.3389/fneur.2026.1890975/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Adjunctive extracorporeal shock wave therapy after botulinum toxin type A injection for post-stroke spasticity: a systematic review and three-level meta-analysis
AU - Weihao Ke
AU - Lujiang Wang
AU - Wenli Shen
AU - Min Chen
AU - Zhenyu Wang
PY - 2026
DA - 2026/10/20
JO - Frontiers in Neurology
DO - 10.3389/fneur.2026.1890975
UR - https://www.frontiersin.org/articles/10.3389/fneur.2026.1890975/full
AB - 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 .
SN - 1664-2295
ER -