Efficacy of extracorporeal shock wave therapy for knee tendinopathies and other soft tissue disorders: A meta-analysis of randomized controlled trials

Chun De Liao, Guo Min Xie, Jau Yih Tsauo, Hung Chou Chen, Tsan Hon Liou

研究成果: 雜誌貢獻文章

3 引文 (Scopus)

摘要

Background: Extracorporeal shock-wave therapy (ESWT), which can be divided into radial shock-wave therapy (RaSWT) and focused shock-wave therapy (FoSWT), has been widely used in clinical practice for managing orthopedic conditions. The aim of this study was to determine the clinical efficacy of ESWT for knee soft tissue disorders (KSTDs) and compare the efficacy of different shock-wave types, energy levels, and intervention durations. Methods: We performed a comprehensive search of online databases and search engines without restrictions on the publication year or language. We selected randomized controlled trials (RCTs) reporting the efficacy of ESWT for KSTDs and included them in a meta-analysis and risk of bias assessment. The pooled effect sizes of ESWT were estimated by computing odds ratios (ORs) with 95% confidence intervals (CIs) for the treatment success rate (TSR) and standardized mean differences (SMDs) with 95% CIs for pain reduction (i.e., the difference in pain relief, which was the change in pain from baseline to the end of RCTs between treatment and control groups) and for restoration of knee range of motion (ROM). Results: We included 19 RCTs, all of which were of high or medium methodological quality and had a Physiotherapy Evidence Database score of ≥5/10. In general, ESWT had overall significant effects on the TSR (OR: 3.36, 95% CI: 1.84-6.12, P < 0.0001), pain reduction (SMD: - 1.49, 95% CI: - 2.11 to - 0.87, P < 0.00001), and ROM restoration (SMD: 1.76, 95% CI: 1.43-2.09, P < 0.00001). Subgroup analyses revealed that FoSWT and RaSWT applied for a long period (≥1 month) had significant effects on pain reduction, with the corresponding SMDs being - 3.13 (95% CI: - 5.70 to - 0.56; P = 0.02) and - 1.80 (95% CI: - 2.52 to - 1.08; P < 0.00001), respectively. Low-energy FoSWT may have greater efficacy for the TSR than high-energy FoSWT, whereas the inverse result was observed for RaSWT. Conclusions: The ESWT exerts an overall effect on the TSR, pain reduction, and ROM restoration in patients with KSTDs. Shock-wave types and application levels have different contributions to treatment efficacy for KSTDs, which must be investigated further for optimizing these treatments in clinical practice.
原文英語
文章編號278
期刊BMC Musculoskeletal Disorders
19
發行號1
DOIs
出版狀態已發佈 - 八月 2 2018

指紋

Convulsive Therapy
Tendinopathy
Meta-Analysis
Knee
Randomized Controlled Trials
Confidence Intervals
Pain
Articular Range of Motion
High-Energy Shock Waves
Shock
Odds Ratio
Databases
Therapeutics
Search Engine
Orthopedics
Publications

ASJC Scopus subject areas

  • Rheumatology
  • Orthopedics and Sports Medicine

引用此文

@article{ed041568e79b495fa8ba323246856198,
title = "Efficacy of extracorporeal shock wave therapy for knee tendinopathies and other soft tissue disorders: A meta-analysis of randomized controlled trials",
abstract = "Background: Extracorporeal shock-wave therapy (ESWT), which can be divided into radial shock-wave therapy (RaSWT) and focused shock-wave therapy (FoSWT), has been widely used in clinical practice for managing orthopedic conditions. The aim of this study was to determine the clinical efficacy of ESWT for knee soft tissue disorders (KSTDs) and compare the efficacy of different shock-wave types, energy levels, and intervention durations. Methods: We performed a comprehensive search of online databases and search engines without restrictions on the publication year or language. We selected randomized controlled trials (RCTs) reporting the efficacy of ESWT for KSTDs and included them in a meta-analysis and risk of bias assessment. The pooled effect sizes of ESWT were estimated by computing odds ratios (ORs) with 95{\%} confidence intervals (CIs) for the treatment success rate (TSR) and standardized mean differences (SMDs) with 95{\%} CIs for pain reduction (i.e., the difference in pain relief, which was the change in pain from baseline to the end of RCTs between treatment and control groups) and for restoration of knee range of motion (ROM). Results: We included 19 RCTs, all of which were of high or medium methodological quality and had a Physiotherapy Evidence Database score of ≥5/10. In general, ESWT had overall significant effects on the TSR (OR: 3.36, 95{\%} CI: 1.84-6.12, P < 0.0001), pain reduction (SMD: - 1.49, 95{\%} CI: - 2.11 to - 0.87, P < 0.00001), and ROM restoration (SMD: 1.76, 95{\%} CI: 1.43-2.09, P < 0.00001). Subgroup analyses revealed that FoSWT and RaSWT applied for a long period (≥1 month) had significant effects on pain reduction, with the corresponding SMDs being - 3.13 (95{\%} CI: - 5.70 to - 0.56; P = 0.02) and - 1.80 (95{\%} CI: - 2.52 to - 1.08; P < 0.00001), respectively. Low-energy FoSWT may have greater efficacy for the TSR than high-energy FoSWT, whereas the inverse result was observed for RaSWT. Conclusions: The ESWT exerts an overall effect on the TSR, pain reduction, and ROM restoration in patients with KSTDs. Shock-wave types and application levels have different contributions to treatment efficacy for KSTDs, which must be investigated further for optimizing these treatments in clinical practice.",
keywords = "Extracorporeal shock wave therapy, Knee, Musculoskeletal disorders, Physical therapy",
author = "Liao, {Chun De} and Xie, {Guo Min} and Tsauo, {Jau Yih} and Chen, {Hung Chou} and Liou, {Tsan Hon}",
year = "2018",
month = "8",
day = "2",
doi = "10.1186/s12891-018-2204-6",
language = "English",
volume = "19",
journal = "BMC Musculoskeletal Disorders",
issn = "1471-2474",
publisher = "BioMed Central",
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TY - JOUR

T1 - Efficacy of extracorporeal shock wave therapy for knee tendinopathies and other soft tissue disorders

T2 - A meta-analysis of randomized controlled trials

AU - Liao, Chun De

AU - Xie, Guo Min

AU - Tsauo, Jau Yih

AU - Chen, Hung Chou

AU - Liou, Tsan Hon

PY - 2018/8/2

Y1 - 2018/8/2

N2 - Background: Extracorporeal shock-wave therapy (ESWT), which can be divided into radial shock-wave therapy (RaSWT) and focused shock-wave therapy (FoSWT), has been widely used in clinical practice for managing orthopedic conditions. The aim of this study was to determine the clinical efficacy of ESWT for knee soft tissue disorders (KSTDs) and compare the efficacy of different shock-wave types, energy levels, and intervention durations. Methods: We performed a comprehensive search of online databases and search engines without restrictions on the publication year or language. We selected randomized controlled trials (RCTs) reporting the efficacy of ESWT for KSTDs and included them in a meta-analysis and risk of bias assessment. The pooled effect sizes of ESWT were estimated by computing odds ratios (ORs) with 95% confidence intervals (CIs) for the treatment success rate (TSR) and standardized mean differences (SMDs) with 95% CIs for pain reduction (i.e., the difference in pain relief, which was the change in pain from baseline to the end of RCTs between treatment and control groups) and for restoration of knee range of motion (ROM). Results: We included 19 RCTs, all of which were of high or medium methodological quality and had a Physiotherapy Evidence Database score of ≥5/10. In general, ESWT had overall significant effects on the TSR (OR: 3.36, 95% CI: 1.84-6.12, P < 0.0001), pain reduction (SMD: - 1.49, 95% CI: - 2.11 to - 0.87, P < 0.00001), and ROM restoration (SMD: 1.76, 95% CI: 1.43-2.09, P < 0.00001). Subgroup analyses revealed that FoSWT and RaSWT applied for a long period (≥1 month) had significant effects on pain reduction, with the corresponding SMDs being - 3.13 (95% CI: - 5.70 to - 0.56; P = 0.02) and - 1.80 (95% CI: - 2.52 to - 1.08; P < 0.00001), respectively. Low-energy FoSWT may have greater efficacy for the TSR than high-energy FoSWT, whereas the inverse result was observed for RaSWT. Conclusions: The ESWT exerts an overall effect on the TSR, pain reduction, and ROM restoration in patients with KSTDs. Shock-wave types and application levels have different contributions to treatment efficacy for KSTDs, which must be investigated further for optimizing these treatments in clinical practice.

AB - Background: Extracorporeal shock-wave therapy (ESWT), which can be divided into radial shock-wave therapy (RaSWT) and focused shock-wave therapy (FoSWT), has been widely used in clinical practice for managing orthopedic conditions. The aim of this study was to determine the clinical efficacy of ESWT for knee soft tissue disorders (KSTDs) and compare the efficacy of different shock-wave types, energy levels, and intervention durations. Methods: We performed a comprehensive search of online databases and search engines without restrictions on the publication year or language. We selected randomized controlled trials (RCTs) reporting the efficacy of ESWT for KSTDs and included them in a meta-analysis and risk of bias assessment. The pooled effect sizes of ESWT were estimated by computing odds ratios (ORs) with 95% confidence intervals (CIs) for the treatment success rate (TSR) and standardized mean differences (SMDs) with 95% CIs for pain reduction (i.e., the difference in pain relief, which was the change in pain from baseline to the end of RCTs between treatment and control groups) and for restoration of knee range of motion (ROM). Results: We included 19 RCTs, all of which were of high or medium methodological quality and had a Physiotherapy Evidence Database score of ≥5/10. In general, ESWT had overall significant effects on the TSR (OR: 3.36, 95% CI: 1.84-6.12, P < 0.0001), pain reduction (SMD: - 1.49, 95% CI: - 2.11 to - 0.87, P < 0.00001), and ROM restoration (SMD: 1.76, 95% CI: 1.43-2.09, P < 0.00001). Subgroup analyses revealed that FoSWT and RaSWT applied for a long period (≥1 month) had significant effects on pain reduction, with the corresponding SMDs being - 3.13 (95% CI: - 5.70 to - 0.56; P = 0.02) and - 1.80 (95% CI: - 2.52 to - 1.08; P < 0.00001), respectively. Low-energy FoSWT may have greater efficacy for the TSR than high-energy FoSWT, whereas the inverse result was observed for RaSWT. Conclusions: The ESWT exerts an overall effect on the TSR, pain reduction, and ROM restoration in patients with KSTDs. Shock-wave types and application levels have different contributions to treatment efficacy for KSTDs, which must be investigated further for optimizing these treatments in clinical practice.

KW - Extracorporeal shock wave therapy

KW - Knee

KW - Musculoskeletal disorders

KW - Physical therapy

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