title: Effects of Extracorporeal Shockwave Therapy in Chronic Stroke Patients With Knee Osteoarthritis: A Pilot Study.
abstract: OBJECTIVE
  To evaluate the effects of extracorporeal shockwave therapy (ESWT) on pain, function, and ultrasonographic features of chronic stroke patients with knee osteoarthritis (OA).
  
  
  METHODS
  A total of 18 chronic stroke patients (33 knee joints) with unilateral or bilateral knee OA (Kellgren-Lawrence grade ≥1) were enrolled in this study. The patients were randomly allocated to an experimental group receiving ESWT (n=9) or a control group receiving sham ESWT (n=9). For the ESWT group, patients received 1,000 pulses weekly for 3 weeks, totaling to an energy dose of 0.05 mJ/mm2on the proximal medial tibia of the affected knee. The assessments were performed before the treatment, immediately after the first treatment, and 1 week after the last treatment using the following: the visual analog scale (VAS) for pain; patient perception of the clinical severity of OA; the Korean version of Modified Barthel Index (ambulation and chair/bed transfer); the Functional Independence Measure scale (FIM; bed/chair/wheelchair transfer, toilet transfer, walking, and stairs); and ultrasonographic features (articular cartilage thickness, Doppler activity, and joint effusion height).
  
  
  RESULTS
  The experimental group showed a significant improvement in VAS score (4.50±1.87 to 2.71±1.38) and patient perception of the clinical severity of OA (1.87±0.83 to 2.75±0.46). The bed/chair/wheelchair transfer components of the FIM score also improved significantly (4.12±1.55 to 4.62±1.30). In terms of the ultrasonographic features, increased Doppler activity was observed in the medial knee in the experimental group immediately following ESWT.
  
  
  CONCLUSIONS
  It is suggested that ESWT may reduce pain and improve function in chronic stroke patients with OA, and may increase vascular activity at the target site.
authors.affiliation: Department of Physical Medicine and Rehabilitation, Veterans Health Service Medical Center, Seoul, Korea.
authors.forename: Sung Jun
authors.identifier: 0000-0002-0297-0049
authors.initials: SJ
authors.lastname: Cho
authors.affiliation: Department of Physical Medicine and Rehabilitation, Veterans Health Service Medical Center, Seoul, Korea.
authors.forename: Ja Ryung
authors.identifier: 0000-0003-0581-5041
authors.initials: JR
authors.lastname: Yang
authors.affiliation: Department of Physical Medicine and Rehabilitation, Veterans Health Service Medical Center, Seoul, Korea.
authors.forename: Hee Seung
authors.identifier: 0000-0003-2492-7065
authors.initials: HS
authors.lastname: Yang
authors.affiliation: Department of Physical Medicine and Rehabilitation, Veterans Health Service Medical Center, Seoul, Korea.
authors.forename: Hea-Eun
authors.identifier: 0000-0002-4449-7288
authors.initials: HE
authors.lastname: Yang
keywords: High-energy shock waves; Knee osteoarthritis; Pain; Stroke; Ultrasonography