Terapia de onda de choque extracorpórea adjuvante após injeção de toxina botulínica tipo A para espasticidade pós-AVC: revisão sistemática e metanálise de três níveis

Resumo original em inglês

O que aconteceu

Post-stroke spasticity is a common rehabilitation problem, and botulinum toxin type A (BTX-A) is a standard focal treatment. Whether extracorporeal shock wave therapy (ESWT) provides clinically relevant additional benefit after BTX-A remains uncertain.

This systematic review and three-level meta-analysis evaluated the add-on effect of ESWT after BTX-A for post-stroke spasticity, with particular attention to impairment-level and activities-of-daily-living outcomes. Methods: PubMed, Embase, Cochrane Library, Web of Science, CNKI, Wanfang Data, VIP, and CBM were searched from inception to March 2026. Randomized controlled trials of BTX-A plus ESWT in adult post-stroke spasticity were included. The primary quantitative synthesis was restricted to BTX-A-based comparators. Hedges' g was pooled with three-level random-effects models to account for dependent effect sizes.

Identifier INPLASY202630010; https://doi.org/10.37766/inplasy2026.3.0010.

O que encontraram

Seven randomized controlled trials with 377 participants met the qualitative criteria, and six trials with 242 participants contributed to the primary quantitative synthesis. Adjunctive ESWT was associated with greater reduction in Modified Ashworth Scale scores (g = 0.87, 95% CI 0.41 to 1.34; p < 0.001) and greater improvement in Fugl-Meyer Assessment scores (g = 1.11, 95% CI 0.45 to 1.76; p < 0.001). Activities-of-daily-living estimates favored the combined intervention but did not reach conventional statistical significance (g = 1.15, 95% CI -0.03 to 2.32; p = 0.056). Two participants developed transient erythema after ESWT, but adverse-event reporting was too incomplete for a comparative safety estimate.

Por que isso importa

Adjunctive ESWT may improve short-term impairment-level outcomes after BTX-A, but certainty is limited and evidence for reliable functional independence gains is very uncertain. Modality-, target-, timing-, and dose-specific findings remain exploratory.

Resumo publicado sob licença CC BY. A tradução para o português ainda não chegou a este estudo.