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This study investigated the efficacy of ESWT as well as the optimal intervention timing for ESWT for patients with spasticity after stroke. A search of randomized controlled trials was conducted in different electronic databases. We performed a meta-analysis to measure the effect of ESWT versus sham interventions on spasticity and limb functionality. The meta-regression analysis was performed to determine the adequate intervention timing of ESWT. The follow-up period of the outcomes was divided into the short (2 weeks), mid (2 we