Journal ESWT Pada Dewasa

J. Phys. Ther. Sci. 30: 361–364, 2018

1. Effects of extracorporeal shock wave therapy on upper extremity muscle tone

in chronic stroke patients
The Journal of Physical Therapy Science

Seung Kyu Park, PhD, PT1), Dae Jung Yang, PhD, PT1), Yo Han Uhm, PhD, PT1), Jong Hyuk Yoon, PT1), Je
Ho Kim, PhD, PT1)*

Department of Physical Therapy, Graduate School of Physical Therapy, Sehan University: 1113 Noksaek-
ro, Samho-eup, Yeongam-gun, Jeollanam-do, Republic of Korea

Abstract. [Purpose] The purpose of this study was to examine the effects of extracorporeal shock wave
therapy (ESWT) on upper extremity muscle tone in chronic stroke patients. [Subjects and Methods] For
this study, 30 stroke patients participated in this study and they were divided into ESWT group and sham-
ESWT group, each group consisted of 15 patients. ESWT and sham-ESWT was performed by the patients
for two times a week, for eight weeks. MyotonPRO was used to measure muscle tone. [Results] According
to the results of the comparisons between the groups, after intervention, upper extremity muscle tone
were significantly higher in the ESWT group than in the sham-ESWT group. [Conclusion] This study showed
that ESWT is effective for improving decrease of muscle tone in chronic stroke patients. Key words: Stroke,
Muscle tone, ESWT

SUBJECTS AND METHODS This study was approved by Bioethics Committee of Sehan University Center
(IRB) (Approval number: 2016-8) on August 1, 2016. This study included 30 patients who had been
hospitalized due to post-stroke hemiplegia. All of the study subjects met the inclusion criteria, which
included 1) stroke diagnosed at least six months ago; 2) ability to communicate with scores of 24 or higher
in the Korean version of the mini-mental state examination; 3) hypertonia with 1–2 modified Ashworth
scale levels; 4) no severe contracture of the elbow and wrist; and 5) no other medical conditions (internal
medicine or surgical). Subjects were excluded if they had undergone botulinum toxin or phenol injection
in the last three months, and any medication administration status or dose that could influence spasticity
remained unmodified (Table 1). The subjects of this study were randomly selected into ESWT group
(Group I) and sham-ESWT group (Group II). General physical therapy was conducted including
development therapy for the central nervous system before ESWT and sham-ESWT. The JEST-2000
(JOEUN Medical, Dae-Jeon, South Korea) was used for the ESWT. The ESWT were focused in the flexor
hypertonic muscle of the forearm and the interosseous muscles of the hand: 1,500 shots were used to
treat flexor muscles of the forearm mainly in the middle of the belly, and 3,200 shots for interosseous
muscles of the hand (800 for each muscle). The energy applied was 0.03 mJ/mm2. Placebo treatment
(sham-ESWT) without shock wave energy was applied with the same instrumentation, and the same
sound was used in all patients. The ESWT was performed over the flexor carpi ulnaris and radialis, and
over intrinsic muscles and flexor digitorum tendon of the hand12) . ESWT and sham-ESWT was performed
by the patients for two times a week, for eight weeks. Mechanical properties of muscles, such as tone,
stiffness, and elasticity, were measured using the MyotonPRO (Myoton AS, Tallinn, Estonia). The tone of
the flexor carpi ulnaris and radialis as well as the flexor digitorum was measured with the patient in a
supine position to minimize the influence of posture on muscle tone13) . Fugl-Meyer Assessment (FMA)
assesses motor function recovery after stroke and consists of 33 and 17 performance items in the upper
and lower limbs, respectively. The scores range from 0 (unable to perform), to 1 (partial ability to
perform), to 2 (near normal ability to perform). The item that measure wrist control and hand function
have been revealed to have excellent intra rater reliability and high interrater reliability14) . A Window
SPSS ver 18.0 statistical software was used for analysis of the results of this study. Descriptive statistics
were used for the characteristics of subject, and analysis of covariance (ANCOVA) was conducted to
examine the difference in upper extremity muscle tone before and after the intervention between groups.
Statistical significance level was α=0.05.

RESULTS According to the results of comparisons between the groups after the intervention, mechanical
properties of FCU and FCR, FD were significantly higher in the group I than in the group II (p<0.05).

FCU : Flexor Carpi Ulnaris

FCR : Flexor Carpi Radialis

FD : Flexor digitorum

International Journal of Surgery 24 (2015) 210e217

2.Extracorporeal shock wave therapy (ESWT) for the treatment of cellulite e A

current metaanalysis
Karsten Knobloch a, * , Robert Kraemer

a SportPraxis Prof. Dr. Karsten Knobloch, Hannover, Germany

Received 16 June 2015

Accepted 11 July 2015

Available online 22 July 2015

Abstract

Background: The aim of this metaanalysis was to investigate the effectiveness of extracorporeal shock
wave therapy (ESWT) in cellulite. Methods: Electronic databases (such as Ovid MEDLINE, Scopus and Ovid)
as well as reference lists of the available studies were evaluated in June 2015 by two expert examiners.
Assessment of each study's methodological quality was performed with the help of the published quality
index tool by Downs and Black. Results: This metanalysis included a total of eleven clinical trials on the
effects of ESWT on cellulite with a total of 297 included females. Among the eleven clinical trials five
randomized controlled trials on ESWT in cellulite with a total number of 123 females have been published
so far. Both, focused as well as radial ESWT devices have been found effective in treating cellulite so far.
Typically, one or two sessions per week and six to eight sessions overall were studied in the published
clinical trials. Overall, outcome parameters mainly focused on digital standardized photographs,
circumference measurements and specific ultrasound examinations. Reporting quality showed substantial
heterogenity from 22 to 82 points with a mean of 57 points. Discussion: This metanalysis identified eleven
published clinical studies on ESWT in cellulite with five randomized-controlled trials among them. There
is growing evidence that both, radial as well as focused ESWT and the combination of both are able to
improve the degree of cellulite. Typically, six to eight treatments once or twice a week have been studied.
Long-term follow-up data beyond one year are lacking as well as details on potential combination
therapies in cellulite such as with low level laser therapy (LLLT), cryolipolysis and others

Methods
All studies included in this review were obtained after an electronic search. In June 2015 the database
search was performed in Ovid Medline (www.pubmed.gov) and Scopus and Ovid in the English published
studies using the following terms:

1. Cellulite and either

2. Extracorporeal shock wave therapy

3. ESWT

4. Shock wave

5. Acoustic wave

6. Treatment

7. Therapy

A hand search followed the electronic assessment. Abstracts were reviewed and analysed accordingly.
Study design, inclusion and exclusion criteria, shockwave treatment modalities (device type, energy flux
densities, number and timing of treatments) as well as the outcome measures determined were of distinct
interest

2.1. Methodological quality assessment The quality index tool published by Sara Downs and Black [5] was
applied to determine the study quality of the included studies. It is an appropriate tool for both,
randomized and nonrandomized trials with a high Test-retest and inter-rater reliability. This assessment
was done by two independent analysts and the mean value was determined.

ERECTILE FUNCTION

3. Effect of Low-Energy Linear Shockwave Therapy on Erectile Dysfunction—A Double-Blinded,

Sham-Controlled, Randomized Clinical Trial
Grzegorz L. Fojecki, MD,1 Stefan Tiessen, MD,2 and Palle J. S. Osther, MD, PhD3

Received August 17, 2016. Accepted November 10, 2016.

1 Department of Urology, Hospital of Southern Jutland, University of Southern Denmark, Sønderborg,

Denmark. Copyright ª 2016, The Authors. Published by Elsevier Inc. on behalf of the International Society
for Sexual Medicine. This is an open access article under the CC BY-NC-ND license
(http://creativecommons.org/ licenses/by-nc-nd/4.0/). http://dx.doi.org/10.1016/j.jsxm.2016.11.307

ABSTRACT

Introduction: Previous studies have shown that focal low-energy extracorporeal shockwave therapy (Li-
ESWT) can have a positive effect in men with erectile dysfunction (ED). Linear Li-ESWT (LLi-ESWT) for ED
has not been previously assessed in a randomized trial.

Aim: To evaluate the treatment outcome of LLi-ESWT for ED.

Methods: Men with ED (n ¼ 126) and a score lower than 25 points on the International Index of Erectile
Function erectile function domain (IIEF-EF) were included. Subjects were allocated to receive LLi-ESWT
once a week for 5 weeks or sham treatment once a week for 5 weeks. After a 4-week break, the two
groups received active treatment once a week for 5 weeks. Subjects completed the IIEF, Erection Hardness
Scale (EHS), Sexual Quality of LifeeMen, and the Erectile Dysfunction Inventory of Treatment Satisfaction
at baseline, after 9 weeks, and after 18 weeks.

Main Outcome Measures: The primary outcome measurement was an increase of at least five points on
the IIEF-EF score. The secondary outcome measurement was an increased EHS score to at least 3 in men
with a score no higher than 2 at baseline. Data were analyzed by linear and logistic regression.

Results: Mean IIEF-EF scores were 11.5 at baseline (95% CI ¼ 9.8e13.2), 13.0 after five sessions (95% CI ¼
11.0e15.0), and 12.6 after 10 sessions (95% CI ¼ 11.0e14.2) in the sham group and correspondingly 10.9
(95% CI ¼ 9.1e12.7), 13.1 (95% CI ¼ 9.3e13.4), and 11.8 (95% CI ¼ 10.1e13.4) in the ESWT group. Success
rates based on IIEF-EF score were 38.3% in the sham group and 37.9% in the ESWT group (odds ratio ¼
0.95, 95% CI ¼ 0.45e2.02, P ¼ .902). Success rates based on EHS score were 6.7% in the sham group and
3.5% in the ESWT group (odds ratio ¼ 0.44, 95% CI ¼ 0.08e2.61, P ¼ .369). A limitation of this study is that
device settings (number of shockwaves and penetration depth) were estimated based on an existing trial
on focused ESWT.

Conclusion: No clinically relevant effect of LLi-ESWT on ED was found. J Sex Med 2017;14:106e112.
Copyright 2016, The Authors. Published by Elsevier Inc. on behalf of the International Society for Sexual
Medicine. This is an open access article under the CC BY-NC-ND license (http://
creativecommons.org/licenses/by-nc-nd/4.0/).

Key Words: Erectile Dysfunction; Extracorporeal Shockwave Therapy

METHODS

The study was conducted as a randomized, double-blinded, sham-controlled study in the Region of
Southern Denmark. Men were recruited after an article promoting the trial was published in a local
newspaper.14 Men applying to participate in the study sent an email directly to the investigator or
requested their general practitioner for a referral to our clinic. Patients complaining of ED during a
consultation at our outpatient clinic for other indications also were offered participation in the trial.
Included were men at least 40 years old in stable relationships who had the complaint of ED for at least 6
months. During the first visit, subjects were screened according to the eligibility criteria and filled out the
erectile function domain of the Internation Index of Erectile Function (IIEF-EF) questionnaire. We obtained
the subjects’ medical history and performed a physical examination. Subjects received a written
information form and were offered consideration time. Serum glucose, lipid profile, and total testosterone
level were assessed. When subjects met the inclusion criteria and returned a signed consent form, they
could enter the trial. All subjects consented not to use other therapies for ED during the study period.
Participants previously treated for ED ceased therapy 4 weeks before entering the study. Detailed
inclusion and exclusion criteria are listed in Table 1. A patient flow diagram is presented in Figure 1.

Participants gave written informed consent before the study. The regional ethics committee (project ID-
20120028), the Danish Ministry of Health (DHMA 2013073909; CIV-13-07- 011546), and the regional data
protection agency approved the study. An independent good clinical practice unit at the University of
Southern Denmark monitored the research process. The trial is registered at www.Clinicaltrials.gov
(NCT02063061). The study was carried out in the Department of Urology at the Hospital of Southern
Jutland in Sønderborg, Denmark. This unit is responsible for the primary urologic care of more than
250,000 inhabitants in southern Denmark within a range of 100 km. Screening of participants was
performed from February 2014 through April 2014. Follow-up was carried out from June 2014 through
August 2014.

4.Extracorporeal shockwave therapy (ESWT) in the treatment of atrophic non-

unions of femoral shaft fractures
Shu-Jui Kuo a , I-Chang Su b , Ching-Jen Wang c, d, * , Jih-Yang Ko c, d

a Department of Orthopedic Surgery, China Medical University Hospital, Taichung, 40447, Taiwan b
Division of Neurosurgery, Department of Surgery, Cathay General Hospital, Taipei, 10630, Taiwan c
Department of Orthopedic Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University
College of Medicine, Kaohsiung, Taiwan d Department of Medical Research, Center for Shockwave
Medicine and Tissue Engineering, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University
College of Medicine, Kaohsiung, Taiwan

Article history:

Received 26 March 2015

Received in revised form 16 June 2015

Accepted 30 June 2015

Available online 9 July 2015

Abstract

Introduction: As of now, the role of extracorporeal shockwave therapy (ESWT) in the treatment of
atrophic non-unions is inconclusive. The purpose of the study was to investigate the effectiveness of ESWT
and the role of this technology in the treatment of atrophic non-union of femurs.

Methods: We retrospectively analyzed 22 patients treated between July 1999 and September 2007 in our
hospital with ESWT for atrophic non-unions of isthmic femoral shaft fractures that were initially treated
surgically using closed reamed nailing procedure. Patients with open fractures, skeletal immaturity, on
anti-osteoporotic medications, with infections, pathological fractures, smokers, with systemic disease
compromising bone healing, and excessive deformity were excluded from this study. Due to incomplete
follow-up one (1) patient who moved abroad after ESTW treatment was not included in this study and as
part of the 22-patients cohort. Radiographs were obtained before treatment and once a month after
treatment for 12 months.
Results: Using ESWT we showed that 14 fractures out of 22 (63.6%) achieved bony union with an average
union time of 9.2 months (range 6e13 months). The union rate was 100% (8 of 8 cases) when ESWT was
performed within 12 months from closed reamed nailing surgery versus 42.9% (6 of 14 cases) when ESWT
was performed after 12 months from initial surgery. The eight (8) patients out of the total 22 patients
cohort, who did not achieve bony union after ESWT, received subsequent treatment with bone grafting
with augmentative plating surgery and all achieved bony union within 5 months after intervention.

Conclusion: For patients with atrophic non-unions of femoral shaft fractures, ESWT can be used as an
alternative and effective non-invasive method of treatment. ESWT treatment does not negatively
influence/compromise previous surgeries and if needed it can be followed by additional surgeries without
any complications