Date of Presentation
5-2-2024 12:00 AM
College
Rowan-Virtua School of Osteopathic Medicine
Poster Abstract
Background: Stroke is the fifth leading cause of death in the United States with 162,553 deaths per year in 2023 alone. Despite technological advances, pain management post-stroke remains limited. To date, hemiplegic shoulder pain (HSP) has an 80-84% prevalence in the United States in post-stroke patients. Non-invasive treatments such as extracorporeal shockwave therapy (ESWT) and pulsed radio frequency (PRF) are commonly used modalities to manage HSP. Given this information, it is important to assess the efficacy of different interventions in order to efficiently manage pain in this patient population. To date there are no systematic reviews or meta-analyses comparing the efficacy of ESWT to PFR on hemiplegic shoulder pain in post-stroke patients.
Purpose: This systematic review and meta-analysis assesses the efficacy of ESWT or PRF in reducing hemiplegic shoulder pain post-stroke, 1 month post-treatment.
Methods: The systematic review and meta-analysis followed the 2020 PRISMA guidelines. Five online databases (Pubmed, Embase, Web Of Science, Scopus, Cochrane) were screened. The analysis included randomized controlled trials (RCTs) and prospective studies that reported 4-week visual analogue scale (VAS) or numerical rating scale (NRS) scores of hemiplegic shoulder pain in stroke patients. 7 studies were included in the final analysis, yielding a total of 84 distinct patient evaluations.
Results: VAS scores between the two groups revealed that ESWT is more efficient at decreasing hemiplegic shoulder pain than PRF at 4 weeks post-treatment. The results analyzed are both statistically significant (p = 0.03) and clinically significant (difference of Cohen’s d = 2.78, 95% CI 1.33 - 4.24).
Conclusion: ESWT is more successful at treating hemiplegic shoulder pain in post-stroke patients, at the 4-week time point assessed in this analysis. Although PRF still portrays a benefit in pain reduction in this population of patients, ESWT showed larger improvements in pain perception as measured using the VAS/NRS scales. Future RCTs comparing the use of ESWT to a placebo in larger sample sizes over a greater time period would be beneficial in solidifying our findings for clinical use.
Keywords
Extracorporeal Shockwave Therapy, ESWT, Pulsed Radio Frequency, PRF, hemiplegic shoulder pain, stroke pain management
Disciplines
Anesthesia and Analgesia | Medicine and Health Sciences | Neurology | Pathological Conditions, Signs and Symptoms | Therapeutics
Document Type
Poster
DOI
10.31986/issn.2689-0690_rdw.stratford_research_day.210_2024
Included in
Anesthesia and Analgesia Commons, Neurology Commons, Pathological Conditions, Signs and Symptoms Commons, Therapeutics Commons
A Systematic Review and Meta-analysis Comparing the Efficacy of Extracorporeal Shockwave Therapy to Pulsed Radio Frequency in Reducing Hemiplegic Shoulder Pain in Post-Stroke Patients
Background: Stroke is the fifth leading cause of death in the United States with 162,553 deaths per year in 2023 alone. Despite technological advances, pain management post-stroke remains limited. To date, hemiplegic shoulder pain (HSP) has an 80-84% prevalence in the United States in post-stroke patients. Non-invasive treatments such as extracorporeal shockwave therapy (ESWT) and pulsed radio frequency (PRF) are commonly used modalities to manage HSP. Given this information, it is important to assess the efficacy of different interventions in order to efficiently manage pain in this patient population. To date there are no systematic reviews or meta-analyses comparing the efficacy of ESWT to PFR on hemiplegic shoulder pain in post-stroke patients.
Purpose: This systematic review and meta-analysis assesses the efficacy of ESWT or PRF in reducing hemiplegic shoulder pain post-stroke, 1 month post-treatment.
Methods: The systematic review and meta-analysis followed the 2020 PRISMA guidelines. Five online databases (Pubmed, Embase, Web Of Science, Scopus, Cochrane) were screened. The analysis included randomized controlled trials (RCTs) and prospective studies that reported 4-week visual analogue scale (VAS) or numerical rating scale (NRS) scores of hemiplegic shoulder pain in stroke patients. 7 studies were included in the final analysis, yielding a total of 84 distinct patient evaluations.
Results: VAS scores between the two groups revealed that ESWT is more efficient at decreasing hemiplegic shoulder pain than PRF at 4 weeks post-treatment. The results analyzed are both statistically significant (p = 0.03) and clinically significant (difference of Cohen’s d = 2.78, 95% CI 1.33 - 4.24).
Conclusion: ESWT is more successful at treating hemiplegic shoulder pain in post-stroke patients, at the 4-week time point assessed in this analysis. Although PRF still portrays a benefit in pain reduction in this population of patients, ESWT showed larger improvements in pain perception as measured using the VAS/NRS scales. Future RCTs comparing the use of ESWT to a placebo in larger sample sizes over a greater time period would be beneficial in solidifying our findings for clinical use.