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Extracorporeal Shock Waves Versus Botulinum Toxin Type A in the Treatment of Poststroke Upper Limb Spasticity: A Randomized Noninferiority Trial
- Source :
- Archives of Physical Medicine and Rehabilitation. 99:2143-2150
- Publication Year :
- 2018
- Publisher :
- Elsevier BV, 2018.
-
Abstract
- Objective To investigate whether extracorporeal shock wave therapy (ESWT) is noninferior to botulinum toxin type A (BoNT-A) for the treatment of poststroke upper limb spasticity. Design Randomized noninferiority trial. Setting Referral medical center. Participants Patients (N=42) with chronic stroke (28 men; mean age, 61.0±10.6y). Interventions Patients received either ESWT or BoNT-A. During the study period, all patients continued their regular rehabilitation. Main Outcome Measures Assessments were performed at baseline and at 1, 4, and 8 weeks after the intervention. The primary outcome was the change from baseline of the modified Ashworth scale (MAS) score of the wrist flexors at week 4. Secondary outcomes included the change of the MAS scores, Tardieu angles of the wrist and elbow flexors, wrist and elbow passive range of motion (PROM), and upper extremity Fugl-Meyer Assessment (UE-FMA) score during the study period, as well as the treatment response rate. Results The primary outcome result in the ESWT group (−0.80±0.41) was similar to that in the BoNT-A group (−0.90±0.44), with a higher confidence limit (0.4) for the difference between groups within the prespecified margin of 0.5, indicating the noninferiority of ESWT to BoNT-A. The response rate was not significantly different between the 2 groups. Both groups showed significant improvement in secondary outcomes relative to baseline; however, the ESWT group yielded greater improvement in wrist and elbow PROM and UE-FMA score. Conclusion Our results suggest that ESWT is a noninferior treatment alternative to BoNT-A for poststroke upper limb spasticity. ESWT and BoNT-A caused similar reduction in spasticity of the wrist and elbow flexors; however, ESWT yielded greater improvement in wrist and elbow PROM and UE-FMA score.
- Subjects :
- Extracorporeal Shockwave Therapy
Male
musculoskeletal diseases
030506 rehabilitation
medicine.medical_specialty
Modified Ashworth scale
medicine.medical_treatment
Elbow
Physical Therapy, Sports Therapy and Rehabilitation
Prom
Wrist
Upper Extremity
03 medical and health sciences
0302 clinical medicine
medicine
Humans
Spasticity
Botulinum Toxins, Type A
Range of Motion, Articular
Stroke
Aged
Rehabilitation
business.industry
Stroke Rehabilitation
Middle Aged
medicine.disease
body regions
Treatment Outcome
medicine.anatomical_structure
Neuromuscular Agents
Muscle Spasticity
Chronic Disease
Physical therapy
Female
medicine.symptom
0305 other medical science
Range of motion
business
030217 neurology & neurosurgery
Subjects
Details
- ISSN :
- 00039993
- Volume :
- 99
- Database :
- OpenAIRE
- Journal :
- Archives of Physical Medicine and Rehabilitation
- Accession number :
- edsair.doi.dedup.....3bfae26a196c587ccd2d89735787db95