Shockwave Therapy or Acupoint Stimulation Combined With Physiotherapy for Spasticity and Motor Function in Post‐Stroke Recovery: A Randomized Controlled Trial

BACKGROUND: Stroke frequently causes spasticity and motor impairment, reducing independence. Non-invasive treatments like radial extracorporeal shockwave therapy (ESWT) and acupoint-based transcutaneous electrical nerve stimulation (Acu-TENS) show potential, but direct comparisons with physiotherapy are limited. AIMS: To investigate the effectiveness of radial ESWT and Acu-TENS, combined with usual physiotherapy treatment (UPT), in spasticity and motor function during post-stroke recovery. METHODS: This trial included 120 participants, randomly allocated to three groups (n = 40 each): ESWT+UPT, Acu-TENS+UPT, or UPT alone. Interventions were administered three times weekly for 6 weeks. Primary outcomes included spasticity (Modified Ashworth Scale, MAS), spasticity control (Modified Tardieu Scale, MTS), and motor function (Fugl-Meyer Assessment, FMA). Secondary outcomes were stroke-specific quality of life (SS-QOL) and functional mobility (10-Meter Walk Test, 10MWT). Assessments were conducted at baseline, post-intervention (6 weeks), and follow-up (18 weeks). RESULTS: Significant time and group effects were observed across all outcomes (p < 0.001). For MAS, ESWT and Acu-TENS showed non-significant differences in U/L (6 weeks: MD = -0.175, p = 0.620; 18 weeks: MD = -0.125, p = 1.000) and L/L (6 weeks: MD = -0.075, p = 1.000; 18 weeks: MD = -0.025, p = 1.000). MTS was significantly superior with ESWT in U/L at 6 weeks (MD = 1.584, p = 0.010) and 18 weeks (MD = 1.419, p = 0.022), whereas L/L differences were slightly greater but non-significant (6 weeks: MD = 1.500, p = 0.122; 18 weeks: MD = 1.500, p = 0.080). FMA was comparable at 6 weeks (U/L: MD = 2.461, p = 0.087; L/L: MD = 0.896, p = 0.958), with ESWT showing significant superiority in U/L at 18 weeks (MD = 3.611, p = 0.010). For SS-QOL and 10MWT, differences were non-significant at 6 weeks (SS-QOL: MD = 4.270, p = 0.714; 10MWT: MD = -1.561, p = 0.115) but slightly greater or superior with ESWT at 18 weeks (SS-QOL: MD = 4.605, p = 0.209; 10MWT: MD = -1.815, p = 0.020). CONCLUSION: Both ESWT and Acu-TENS with physiotherapy reduced spasticity and improved motor function, mobility, and SS-QOL in post-stroke patients. ESWT showed slightly greater gains, but differences were mostly not significant, indicating both are useful additions to physiotherapy. TRIAL REGISTRATION: CTRI/2025/05/087383.