| 摘要 |
[Objectives] To quantify the efficacy of Extracorporeal Shock Wave Therapy (ESWT) for upper limb spasticity in stroke patients using Modified Ashworth Scale (MAS) across three timeframes: immediate, short-term (24 h-4 wks), and long-term (>4 wks). [Methods] Six databases (PubMed, EMBASE, CENTRAL, CINAHL, Scopus, Web of Science) until May 2025, were systematically searched, identifying 11 RCTs (n=505) meeting inclusion criteria (adults ≥18 yrs old with stroke-related spasticity [MAS≥1]). Risk of bias was rigorously assessed using Cochrane criteria, revealing uniformly low risk across all domains. Random-effects meta-analyses (REML model) calculated Hedges’ g with 95% CI for MAS outcomes, with subgroup analyses for joint-specific effects. [Results] ESWT demonstrated non-significant immediate MAS reduction (g=-0.69, p=0.07;=93.95%), but statistically significant short-term (g=-0.58, p=0.02; I2=89.64%) and long-term effects (g=-0.52, p=0.02; I2=78.72%). Effects were driven by composite MAS scores (short-term g=-0.63; long-term g=-0.56, both p<0.05) rather than isolated joints (elbow/finger/wrist all non-significant). Substantial heterogeneity persisted across analyses, particularly in joint-specific subgroups (I2>90%). [Conclusions] ESWT provides statistically significant, clinically relevant reductions in global upper limb spasticity with durable efficacy beyond four weeks, supporting its use as a non-invasive adjunct therapy despite substantial heterogeneity warranting protocol standardization. |
