Taheri Parisa, Vahdatpour Babak, Mellat Maryam, Ashtari Fereshteh, Akbari Mojtaba
Department of Physical Medicine and Rehabilitation, Isfahan University of Medical Sciences, Isfahan, Iran.
Department of Neurology, Isfahan Neurological Sciences Research Centre, Isfahan Medical Education Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
Arch Iran Med. 2017 Jun;20(6):338-343.
This study aims to evaluate the effect of extracorporeal shock wave therapy (ESWT) on lower limb spasticity in stroke patients.
Twenty-eight eligible patients with ankle plantar flexor spasticity were randomly assigned to two groups. ESWT group received 1 session per week for 3 weeks of ESWT along with oral anti-spastic medications and stretching exercises. The control group received only oral anti-spastic medications and stretching exercises similar to ESWT group. At baseline, weeks 1, 3 and 12, spasticity was assessed and compared between the two groups using Modified Ashworth Scale (MAS), clonus score, passive range of motion (ROM) of joint, pain score, 3-m walk duration and lower extremity functional score (LEFS). Three patients were lost during follow-up; 25 patients completed the study and were analyzed.
After one session of ESWT treatment, MAS, pain, ROM and LEFS improved significantly compared to baseline. After three weeks of ESWT treatment, MAS, pain and 3-m walk duration improved significantly compared to week 1. At week 12, MAS, pain, ROM, 3-m walk duration and LEFS improved significantly compared to the control group after controlling baseline values. The trend of decrease in pain score and MAS was significantly different between the groups. The trend of increase in ROM and LEFS was significantly different between the groups.
ESWT significantly improved lower limb spasticity, pain, passive ROM, 3-m walk duration and LEFS immediately and 12 weeks after treatment. So, ESWT in combination with oral anti-spastic medications and stretching exercises could be useful for improvement of spasticity in stroke patients.
本研究旨在评估体外冲击波疗法（ESWT）对中风患者下肢痉挛的影响。
28例符合条件的踝关节跖屈痉挛患者被随机分为两组。ESWT组每周接受1次ESWT治疗，共3周，同时服用口服抗痉挛药物并进行伸展运动。对照组仅接受与ESWT组类似的口服抗痉挛药物和伸展运动。在基线、第1周、第3周和第12周，使用改良Ashworth量表（MAS）、阵挛评分、关节被动活动范围（ROM）、疼痛评分、3米步行持续时间和下肢功能评分（LEFS）对两组的痉挛情况进行评估和比较。随访期间有3例患者失访；25例患者完成研究并进行分析。
与基线相比，一次ESWT治疗后，MAS、疼痛、ROM和LEFS有显著改善。ESWT治疗3周后，与第1周相比，MAS、疼痛和3米步行持续时间有显著改善。在第12周，在控制基线值后，与对照组相比，MAS、疼痛、ROM、3米步行持续时间和LEFS有显著改善。两组间疼痛评分和MAS的下降趋势有显著差异。两组间ROM和LEFS的增加趋势有显著差异。
ESWT在治疗后即刻和12周时显著改善了下肢痉挛、疼痛、被动ROM、3米步行持续时间和LEFS。因此，ESWT联合口服抗痉挛药物和伸展运动可能有助于改善中风患者的痉挛情况。
