Extracorporeal Shock Waves Versus Botulinum Toxin Type A in the Treatment of Poststroke Upper Limb Spasticity: A Randomized Noninferiority Trial.

OBJECTIVE: To investigate whether extracorporeal shock wave therapy (ESWT) is noninferior to botulinum toxin type A (BoNT-A) for the treatment of poststroke upper limb spasticity. DESIGN: Randomized noninferiority trial. SETTING: Referral medical center. PARTICIPANTS: Patients (N=42) with chronic stroke (28 men; mean age, 61.0±10.6y). INTERVENTIONS: Patients received either ESWT or BoNT-A. During the study period, all patients continued their regular rehabilitation. MAIN OUTCOME MEASURES: Assessments were performed at baseline and at 1, 4, and 8 weeks after the intervention. The primary outcome was the change from baseline of the modified Ashworth scale (MAS) score of the wrist flexors at week 4. Secondary outcomes included the change of the MAS scores, Tardieu angles of the wrist and elbow flexors, wrist and elbow passive range of motion (PROM), and upper extremity Fugl-Meyer Assessment (UE-FMA) score during the study period, as well as the treatment response rate. RESULTS: The primary outcome result in the ESWT group (-0.80±0.41) was similar to that in the BoNT-A group (-0.90±0.44), with a higher confidence limit (0.4) for the difference between groups within the prespecified margin of 0.5, indicating the noninferiority of ESWT to BoNT-A. The response rate was not significantly different between the 2 groups. Both groups showed significant improvement in secondary outcomes relative to baseline; however, the ESWT group yielded greater improvement in wrist and elbow PROM and UE-FMA score. CONCLUSION: Our results suggest that ESWT is a noninferior treatment alternative to BoNT-A for poststroke upper limb spasticity. ESWT and BoNT-A caused similar reduction in spasticity of the wrist and elbow flexors; however, ESWT yielded greater improvement in wrist and elbow PROM and UE-FMA score.

Statin Use and the Risk of Dementia in Patients with Stroke: A Nationwide Population-Based Cohort Study.

BACKGROUND: Patients with stroke have an increased risk of dementia. Some studies have found that statin use might lower the risk of incident dementia; however, there is still a lack of data from patients with stroke. Therefore, the aim of our study was to investigate the impact of statin use on the risk of dementia in patients with stroke. METHODS: We used the National Health Insurance Research Database in Taiwan to identify 14,807 patients diagnosed with stroke from 1997 to 2005. These patients were classified as statin users and nonusers. Propensity score matching was performed to balance selected confounders between the statin users and nonusers. Cox proportional hazard regression models were used to evaluate the association between statin use and the risk of dementia. RESULTS: During the follow-up period (median, 7.5 years), 1895 patients were diagnosed with incident dementia. Statin use was associated with a significantly lower incidence of dementia (adjusted hazard ratio, .81; 95% confidence interval, .73-.89) than nonuse was. In particular, lipophilic and high-potency statins were associated with lower risk of dementia. Statin exposure duration was inversely related to the risk of dementia (P < .001 for the trend). No significant effect modification for the relationship between statin use and the risk of dementia was found for either age or sex. CONCLUSION: In this nationwide cohort study, statin use was associated with decreased risk of dementia among patients with stroke. The use of high-potency statins, lipophilic statins, and prolonged exposure to statins may be associated with greater benefits.

Association between the volume of inpatient rehabilitation therapy and the risk of all-cause and cardiovascular mortality in patients with ischemic stroke.

OBJECTIVE: To investigate the relationship between the volume of inpatient rehabilitation therapy and mortality among patients with acute ischemic stroke, as well as to assess whether the association varies with respect to stroke severity. DESIGN: A retrospective study with a cohort of consecutive patients who had acute ischemic stroke between January 1, 2008, and June 30, 2009. SETTING: Referral medical center. PARTICIPANTS: Adults with acute ischemic stroke (N=1277) who were admitted to a tertiary hospital. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Stroke-related mortality. RESULTS: During the median follow-up period of 12.3 months (ranging from January 1, 2008, to December 31, 2009), 163 deaths occurred. Greater volume of rehabilitation therapy was associated with a reduced risk of all-cause and cardiovascular mortality (P for trend <.001 for both). Compared with the first tertile, the third tertile of rehabilitation volume was associated with a 55% lower risk of all-cause mortality (hazard ratio [HR]=.45; 95% confidence interval [CI], .30-.65) and a 50% lower risk of cardiovascular mortality (HR=.50; 95% CI, .31-.82). The association did not vary with respect to stroke severity (P for interaction = .45 and .73 for all-cause and cardiovascular mortality, respectively). CONCLUSIONS: The volume of inpatient rehabilitation therapy and mortality were significantly inversely related in the patients with ischemic stroke. Thus, further programs aimed at promoting greater use of rehabilitation services are warranted.

Comparative Effectiveness of Focused Extracorporeal versus Radial Extracorporeal Shockwave Therapy for Knee Osteoarthritis-Randomized Controlled Study.

Both focused extracorporeal shockwave (f-ESWT) and radial extracorporeal shockwave therapy (r-ESWT) can alleviate symptoms in patients with knee osteoarthritis, but no trials have directly compared f-ESWT with r-ESWT for knee osteoarthritis. This study aimed to compare the effectiveness of f-ESWT and r-ESWT on knee osteoarthritis. Forty-two patients with bilateral knee osteoarthritis were randomly assigned to receive three sessions of either f-ESWT or r-ESWT at 1-week intervals. The patients were evaluated at baseline and at 4 and 8 weeks after the final treatment. The primary outcome was the change in pain intensity, as measured on the visual analog scale (VAS). Secondary outcomes included the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), range of motion of the knee joint, and the 6-minute walk test. At the end of 4 weeks, the VAS score was substantially reduced in both groups (f-ESWT, -4.5 ± 2.5 points; r-ESWT, -2.6 ± 2.0 points), with a greater reduction in the f-ESWT group. Both groups showed significant improvement in secondary outcomes; however, the f-ESWT group yielded greater improvement in the VAS score, WOMAC score, and 6-minute walk test. Our results showed that f-ESWT was more effective than r-ESWT in improving pain and physical function in patients with knee osteoarthritis.