Radial shock waves

This repository contains data and procedures to replicate the figures and tables presented in the related publication: Imamura M. et al. Effect of radial shock waves for the treatment of upper limb functional disability in stroke sequelae: a double-blind randomized sham-controlled trial (submitted to PlosMedicine) Context: Stroke can lead to upper limb disability, and previous studies have shown the effectiveness of radial extracorporeal shock wave therapy (rESWT) in reducing spasticity and promoting functional recovery in patients with stroke sequelae. Objective: This study shows the effect of rESWT on the functional recovery of the upper extremity after ischemic stroke in the territory of the middle cerebral artery. Design, Setting, Participants: We conducted a randomized, double-blind, sham-controlled trial involving 23 patients diagnosed with ischemic stroke. The trial took place at a physical medicine and rehabilitation facility in Sao Paulo, Brazil. Interventions: The patients underwent weekly sessions of rESWT for four consecutive weeks. The treatment involved radial extracorporeal shockwaves applied diffusely to the elbow and wrist flexors in the forearm and hand interosseus. The control treatment utilized a sham handpiece that closely resembled the interventional device but did not emit shockwaves. Outcome Measures: The primary outcome measure was upper limb function, assessed using the Fugl-Meyer Assessment (FMA-UE). Secondary outcome measures included the modified Ashworth Scale (MAS), Medical Research Council Scale (MRC), Grip and Pinch strength, and measurement of cortical integrity by transcranial magnetic stimulation (TMS). Results: Three46 patients of the rESWT group and four of the sham group did not return for follow up and were excluded from the analysis. Differences of clinical conditions of these two randomized groups were not statistically significant (age, time after stroke, mini mental state examination, Hamilton depression scale, stroke impact scale, NIH stroke scale, and functional independence measure), as well as the baseline measures of FMA-UE, MRC, MAS, Grip and Pinch Strength. FMA-UE after eight weeks of treatment was significantly different between the rESWT group (n=9: before 21.8±10.9, after 27.4±11.5) and sham group (n=7: before 13.5±6.6, after 13.9±5.3; ANCOVA t(13)=-2.310, p=0.038). Muscle strength captured by the Medical Research Council (MRC) sum score was also significantly different between both groups (t(13)=-2.910, p=0.012). There was no evidence of statistically significant differences among the other secondary outcomes: MAS of flexor (t(13)=1.708, p=0.111) and extensor muscles (t(13)=0.374, p=0.714), grip strength (t(12)=0.639, p=0.535), and pinch strength (t(12)=-1.586, p=0.139). Conclusion: Treatment effect of rESWT improved functional recovery of patients with chronic ischemic stroke without a detectable motor evoked potential by TMS at baseline.