Relative Effect of Extracorporeal Shockwave Therapy Alone or in Combination with Noninjective Treatments on Pain and Physical Function in Knee Osteoarthritis: A Network Meta-Analysis of Randomized Controlled Trials.

Chun-De Liao,Yu-Yun Huang,Shih-Wei Huang,Che-Li Lin,Hung-Chou Chen,Tsan-Hon Liou

doi:10.3390/biomedicines10020306

Abstract

Extracorporeal shockwave therapy (ESWT) has been recommended for managing pain in patients with knee osteoarthritis (KOA). The difference in therapeutic effects between radial shockwave characteristics (RaSW) and focused shockwave characteristics (FoSW) with different energy levels for KOA remains controversial. The purpose of this network meta-analysis (NMA) was to identify the effects relative to the different ESWT regime and combination treatments on pain and functional outcomes in individuals with KOA. The randomized controlled trials (RCTs) which investigated the efficacy of RaSW, FoSW, and combination treatments in patients with KOA were identified by searches of electronic databases. The included RCTs were analyzed through NMA and risk-of-bias assessment. We analyzed 69 RCTs with a total of 21 treatment arms in the NMA. Medium-energy FoSW plus physical therapy, medium-energy acupoint RaSW plus Chinese medicine, and high-energy FoSW alone were the most effective treatments for reducing pain [standard mean difference (SMD) = −4.51], restoring function (SMD = 4.97), and decreasing joint inflammation (SMD = −5.01). Population area and study quality influenced the treatment outcomes, particularly pain. Our findings indicate that medium-energy ESWT combined with physical therapy or Chinese medicine is beneficial for treating pain and increasing function in adults with KOA.

Highlights

Knee osteoarthritis (KOA) is a serious joint disease and prevalent chronic musculoskeletal disorder, with pain being its primary symptom and main clinical presentation [1,2]
Treatment efficacy ranking of all of the identified Extracorporeal shockwave therapy (ESWT) protocols which were comprised of different shockwave types (i.e., focused shockwave characteristics (FoSW) alone or radial shockwave characteristics (RaSW) alone) and EFD levels is critical for its ability to elucidate the optimal approach among different treatment options for patients with KOA
Our finding indicates that the energy level may be the determinant of ESWT efficacy rather than the shockwave type for pain reduction

Summary

Introduction

Knee osteoarthritis (KOA) is a serious joint disease and prevalent chronic musculoskeletal disorder, with pain being its primary symptom and main clinical presentation [1,2]. KOA impairs musculoskeletal system [4], leading to physical difficulty [2,5,6]. Such musculoskeletal pain in KOA is closely associated with a decline in health state and a negatively. The most common practical problem of KOA is the pain-induced limitation in physical function and mobility, especially walking ability [10–12], stair negotiation [13], and postural transition in activities [10–12]. Under such circumstances, the development of efficient treatment strategies for pain management is essential for individuals with KOA

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