Ann Rehabil Med.  2016 Oct;40(5):862-870. 10.5535/arm.2016.40.5.862.

Effects of Extracorporeal Shockwave Therapy in Chronic Stroke Patients With Knee Osteoarthritis: A Pilot Study

• Cho SJ
• Yang JR
• Yang HS
• Yang HE

• KMID: 2382918
• DOI: http://doi.org/10.5535/arm.2016.40.5.862

Abstract

OBJECTIVE
To evaluate the effects of extracorporeal shockwave therapy (ESWT) on pain, function, and ultrasonographic features of chronic stroke patients with knee osteoarthritis (OA).
METHODS
A total of 18 chronic stroke patients (33 knee joints) with unilateral or bilateral knee OA (Kellgren-Lawrence grade ≥1) were enrolled in this study. The patients were randomly allocated to an experimental group receiving ESWT (n=9) or a control group receiving sham ESWT (n=9). For the ESWT group, patients received 1,000 pulses weekly for 3 weeks, totaling to an energy dose of 0.05 mJ/mm² on the proximal medial tibia of the affected knee. The assessments were performed before the treatment, immediately after the first treatment, and 1 week after the last treatment using the following: the visual analog scale (VAS) for pain; patient perception of the clinical severity of OA; the Korean version of Modified Barthel Index (ambulation and chair/bed transfer); the Functional Independence Measure scale (FIM; bed/chair/wheelchair transfer, toilet transfer, walking, and stairs); and ultrasonographic features (articular cartilage thickness, Doppler activity, and joint effusion height).
RESULTS
The experimental group showed a significant improvement in VAS score (4.50±1.87 to 2.71±1.38) and patient perception of the clinical severity of OA (1.87±0.83 to 2.75±0.46). The bed/chair/wheelchair transfer components of the FIM score also improved significantly (4.12±1.55 to 4.62±1.30). In terms of the ultrasonographic features, increased Doppler activity was observed in the medial knee in the experimental group immediately following ESWT.
CONCLUSION
It is suggested that ESWT may reduce pain and improve function in chronic stroke patients with OA, and may increase vascular activity at the target site.

Keyword

High-energy shock waves; Knee osteoarthritis; Stroke; Ultrasonography; Pain

MeSH Terms

Cartilage
High-Energy Shock Waves
Humans
Joints
Knee*
Osteoarthritis, Knee*
Pilot Projects*
Stroke*
Tibia
Ultrasonography
Visual Analog Scale
Walking

Figure

• 

  Fig. 1 Doppler activity from ultrasonography in the medial joint in the experimental group: (A) before and (B) immediately after the first ESWT session. Increased Doppler activity was observed in the medial joint and most commonly on the distal femoral and proximal tibial surfaces. ESWT, extracorporeal shockwave therapy.

• 

  Fig. 2 Doppler activity from ultrasonography of the medial joint in the experimental group. Doppler activity was also increased on the medial ligament (A) or the medial meniscus (B).

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