Efficacy of extracorporeal shock wave therapy for lower limb tendinopathy: A systematic review and meta-analysis

Abstract

Extracorporeal shock-wave therapy (ESWT), including radial (RaSW) and focused (FoSW) shock-wave types, has been widely used in clinical practice for managing musculoskeletal disorders such as tendinopathy. The difference in therapeutic effects between two shock-wave characteristics with different dosage levels for lower extremity (LE) tendinopathy remains controversial. The purpose of this systematic review and meta-analysis was to determine the difference in effectiveness between RaSW and FoSW as well as between high-dosage (HD) and low-dosage (LD) applications for patients with LE tendinopathy. A comprehensive search of online databases and search engines, namely Medline, PubMed, Excerpta Medica dataBASE, the Cochrane Library Database, the Physiotherapy Evidence Database (PEDro), and Google Scholar, was performed. We included randomized controlled trials (RCTs) and observational studies reporting the efficacy of ESWT in treating LE tendinopathy. The included articles were subjected to a meta-analysis and risk of bias assessment. We finally included 19 RCTs, all of which were of high or good methodological quality, with a PEDro score ≥ 7/10. Meta-analyses revealed significant effects favoring general ESWT at immediate follow-up [pain score: standardized mean difference (SMD) −1.41, 95% confidence interval (CI) −2.01 to −0.82 P < 0.00001; heterogeneity ( I 2 ) = 95%; function: SMD 2.59, 95% CI 1.54 to 3.64 P < 0.00001; I 2 = 97%] as well as at 3, 6, and ≥12 months. In sequence, HD-FoSW, HD-RaSW, and LD-RaSW have superior pooled effects on overall clinical outcomes. ESWT exerts an overall effect on pain and function, particularly in patients with LE tendinopathy. Shock-wave types and dosage levels may have different contributions to treatment efficacy, which must be investigated further for optimizing clinical practice.