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 t echnology 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 12months.
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