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Effects of radial shockwave therapy and orthotics applied with physical training on motor function of children with spastic diplegia: a randomized trial
Elnaggar RK, Abd-Elmonem AM
Physical & Occupational Therapy in Pediatrics 2019;39(6):692-707
clinical trial
7/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: Yes; Adequate follow-up: Yes; Intention-to-treat analysis: No; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

AIMS: To explore the effects of radial shockwave therapy (rSWT) combined with standard orthotic management (SOM) on spasticity, functional balance, and gait in children with spastic diplegia. METHODS: Sixty children with diplegia were allocated to group I (rSWT, n = 20), group II (SOM, n = 20), or group III (rSWT+SOM, n = 20). All groups received a physical training program 3 times/week for 3 months. Assessments were completed before and immediately after the intervention and included the Hoffman reflex/myogenic response ratio of the soleus muscle (H/M ratio), balance, and gait. RESULTS: At a significance criterion adjusted to p < 0.006, there were no between-group differences in balance or gait (p > 0.006). The rSWT+SOM group had a greater improvement of H/M ratio compared to rSWT alone (p = 0.001) but not to SOM alone (p = 0.04). Within-group analysis demonstrated significant improvement of all variables for rSWT+SOM (p < 0.006). The H/M ratio and knee midstance angle exhibited clinically meaningful improvement for rSWT alone (p < 0.006). No significant changes were observed in any variable for SOM alone (p > 0.006). CONCLUSIONS: Radial shockwave and orthotics together, or either of them along with physical training did not differ in improving balance or gait. Their combination was more effective than rSWT alone in reducing spasticity.
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