Clinical efficacy of extracorporeal shockwave therapy for knee osteoarthritis: a systematic review and meta-regression of randomized controlled trials

Chun De Liao, Jau Yih Tsauo, Tsan Hon Liou, Hung Chou Chen, Shih Wei Huang

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Objective: This study determined the clinical efficacy of extracorporeal shockwave therapy and the predictors of its efficacy for knee osteoarthritis. Data Sources: Electronic databases and search engines, namely MEDLINE, PubMed, EMBASE, Cochrane Library Database, Physiotherapy Evidence Database (PEDro), China Academic Journals Full-text Database, and Google Scholar, were searched until 5 March 2019, for randomized controlled trials without restrictions on language and publication year. Review Methods: Eligible trials and extracted data were identified by two independent investigators. The included articles were subjected to a meta-analysis and risk of bias assessment. Outcomes of interest included treatment success rate, pain, and physical function outcomes. A meta-regression analysis was performed to determine the predictors of treatment outcomes following shockwave therapy. Results: We included 50 trials (4844 patients) with a median (range) PEDro score of 6 (5–9). Meta-analyses results revealed an overall significant effect favoring shockwave therapy on the treatment success rate (odds ratio 3.22, 95% confidence interval (CI) 2.21–4.69, P < 0.00001; heterogeneity (I2) = 62%), pain reduction (standardized mean difference (SMD) −2.02, 95% CI −2.38 to −1.67, P < 0.00001; I2 = 95%), and Western Ontario and McMaster Universities Osteoarthritis Index function outcome (SMD −2.71, 95% CI −3.50 to −1.92, P < 0.00001; I2 = 97%). Follow-up duration and energy flux density were independent significant predictors of shockwave efficacy. Conclusion: Shockwave therapy is beneficial for knee osteoarthritis. Shockwave dosage, particularly the energy level and intervention duration, may have different contributions to treatment efficacy.

Original languageEnglish
Pages (from-to)1419-1430
Number of pages12
JournalClinical Rehabilitation
Volume33
Issue number9
DOIs
Publication statusPublished - Sep 1 2019

Keywords

  • Extracorporeal shockwave therapy
  • function outcome
  • knee osteoarthritis
  • pain

ASJC Scopus subject areas

  • Physical Therapy, Sports Therapy and Rehabilitation
  • Rehabilitation

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