Extracorporeal Shock Waves Versus Botulinum Toxin Type A in the Treatment of Poststroke Upper Limb Spasticity: A Randomized Noninferiority Trial

摘要: 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 received either ESWT or BoNT-A. During study period, all patients continued their regular rehabilitation. Main Outcome Measures Assessments were performed at baseline and 1, 4, 8 weeks after intervention. The primary outcome was change from modified Ashworth scale (MAS) score wrist flexors week 4. Secondary outcomes included MAS scores, Tardieu angles elbow flexors, passive range motion (PROM), extremity Fugl-Meyer Assessment (UE-FMA) during as well response rate. Results result in group (−0.80±0.41) similar that BoNT-A (−0.90±0.44), a higher confidence limit (0.4) difference between groups within prespecified margin 0.5, indicating rate not significantly different 2 groups. Both showed significant improvement secondary relative baseline; however, yielded greater PROM UE-FMA score. Conclusion Our results suggest alternative caused reduction spasticity flexors;