Abstract
BackgroundShockwave therapy (SWT) is a commonly used intervention for a number of musculoskeletal conditions with varying clinical outcomes. However, the capacity of SWT to influence pathophysiological processes and the morphology of affected tissues remains unclear. The objective of the current review is to evaluate changes in imaging outcomes of musculoskeletal conditions following SWT.MethodsA comprehensive search of Medline, Embase, Cochrane Controlled Trials Register, CINAHL and SportDiscus was conducted from inception to October 2018. Prospective clinical trials evaluating the effectiveness of SWT based on changes in imaging outcomes were eligible for inclusion. Articles were evaluated independently for risk of bias using the Cochrane Risk of Bias list and the Methodological Index for Non-Randomized Studies. Random-effects meta-analysis and meta-regression with a priori determined covariates was conducted for each condition to determine potential predictors of SWT effects.ResultsSixty-three studies were included, with data from 27 studies available for effect size pooling. Meta-analyses and meta-regression on imaging outcomes were performed for rotator cuff calcific tendinitis (n = 11), plantar fasciitis (n = 7) and osteonecrosis of the femoral head (n = 9). There was an overall reduction in the size of measured lesion following SWT (MD 8.44 mm (95%CI 4.30, 12.57), p < 0.001) for calcium deposit diameter, (MD 0.92 mm (95%CI 0.03, 1.81), p = 0.04) for plantar fascia thickness and (MD 4.84% (95%CI -0.06, 9.75), p = 0.05) for lesion size in femoral head osteonecrosis. Meta-regression showed no influence of SWT dosage parameters, however, baseline lesion size was an independent predictor for changes in imaging outcomes.ConclusionsSWT altered the morphology of musculoskeletal conditions, potentially reflecting changes in underlying pathophysiological processes. The parameters of SWT dosage are not significant predictors of changes in imaging outcomes. Lack of adequate reporting of imaging outcomes limited the conclusions that could be drawn from the current review. Registration number: PROSPERO CRD42018091140.
Highlights
Shockwave therapy (SWT) is a commonly used intervention for a number of musculoskeletal conditions with varying clinical outcomes
Following the removal of duplicates and exclusion of records based on title and abstract screening, a total of 93 studies were available for full-text review
The current review has identified some changes in imaging parameters of musculoskeletal conditions in response to SWT
Summary
Shockwave therapy (SWT) is a commonly used intervention for a number of musculoskeletal conditions with varying clinical outcomes. SWT is often indicated as a secondary conservative treatment choice for recalcitrant musculoskeletal conditions, unresponsive to standard care [1, 3]. These indications include plantar fasciitis, Achilles tendinopathy, patellar tendinopathy, calcific and non-calcific shoulder tendinopathy and lateral epicondylitis. Good evidence based on systematic reviews exists to support the use of SWT for calcific tendinopathy of the shoulder [4], Achilles tendinopathy [5, 6], knee osteoarthritis [7], early stage osteonecrosis of the femoral head [8] and plantar fasciitis [9]. Research evidence for the effectiveness of SWT in lateral epicondylitis is variable [1] and is lacking for patellar tendinopathy [3, 6]
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