Umbrella review finds limited evidence for shock wave therapy in post-stroke spasticity

IntroductionThis umbrella review aims to synthesize and critically evaluate existing systematic reviews and meta-analyses to determine the efficacy of extracorporeal shock wave therapy for post-stroke spasticity, along with the quality and reliability of the evidence.MethodsA comprehensive search of eight databases (up to May 2025) was conducted to identify systematic reviews and meta-analyses evaluating extracorporeal shock wave therapy for post-stroke spasticity. Two scholars independently screened the literature and extracted data. The methodological quality of the included systematic reviews and meta-analyses was appraised using AMSTAR 2, and the certainty of evidence for each outcome was rated using the GRADE approach. Overlap of primary studies across reviews was assessed and visualized using the GROOVE tool.ResultsA total of 17 systematic reviews and meta-analyses were included. Among these, 3 were rated as high quality, 2 as moderate quality, 7 as low quality, and 5 as very low quality. Evidence mapping identified 136 nodes, indicating moderate overlap. All included systematic reviews and meta-analyses suggested that extracorporeal shock wave therapy improves post-stroke spasticity. Extracorporeal shock wave therapy helps reduce spasticity, improve sensorimotor function, increase active and passive range of motion, and alleviate pain.DiscussionThis umbrella review suggests that extracorporeal shock wave therapy can improve post-stroke spasticity symptoms. However, due to the generally low methodological quality of the included systematic reviews and meta-analyses, the existing evidence remains limited and inconclusive. Language restrictions and the predominance of studies from a single country may also limit their generalizability. Further high-quality research is needed to strengthen the evidence base.Systematic review registrationidentifier: CRD420251124065.