Shock Wave Therapy In Patients Research Articles

Immediate effect of extracorporeal shockwave therapy in patients with chronic non-specific low back pain: A randomised placebo-controlled triple-blind trial.

To compare the immediate effects of shockwave therapy using two different tips in patients with chronic non-specific low back pain. Randomised placebo-controlled study with three intervention groups. The patients recruited for this study were sent for physiotherapy treatment at primary care between May and July 2022. Eighty-one patients with chronic non-specific low back pain aged 18-80 years with pain for ≥3 months and pain intensity ≥3 were randomly recruited for the study. The patients received a single intervention of radial shockwave therapy with 2000 discharges at 100 mJ energy and 5 Hz frequency using concave or convex tips or placebo treatment. The primary outcome was pain intensity immediately post-intervention. The secondary outcomes were pressure pain threshold, temporal summation of pain, and functional performance. Data were collected at baseline and post-intervention. The post-intervention pain intensity in the concave tip group is an average of two points lower (95% CI = -3.6, -0.4; p < 0.01) than that in the placebo group. The post-intervention pressure pain threshold for the concave tip group was an average of 62.8 kPa higher (95% CI = 0.4, 125.1; p < 0.05) than for the convex tip group and 76.4 kPa higher (95% CI = 14, 138.7; p < 0.01) than in the placebo group. The concave tip shockwave therapy is effective in reducing pain and local hyperalgesia in patients with chronic non-specific low back pain.

Comparing two protocols of shock wave therapy for patients with plantar fasciitis: A pilot study.

This pilot study primarily aimed to detect the adherence as well as the effect size required to estimate the actual sample size needed for a larger scale study to compare and evaluate the effectiveness of two extracorporeal shock wave therapy (ESWT) protocols along, with a physical therapy program in reducing pain and improving function among patients suffering from plantar fasciitis. The study also aimed to report the effects of the ESWT protocols used on pain and function. A total of 26 participants took part in the study, including 17 females and 9 males. The average age of the participants was 34 years with a body mass index (BMI) of 23 kg/m2. Participants were divided into three equal groups; Group A received ESWT at a frequency of 15 Hz and intensity of 3, Group B received ESWT at a frequency of 10 Hz and intensity of 4, while Group C underwent the selected physical therapy program along with sham shock wave therapy as a control. Pain levels were assessed using the Visual Analog Scale (VAS) while functional improvements were evaluated using the Foot Function Index (FFI). Data was collected prior to treatment, after three sessions and at the end of six weeks (after six sessions). The three groups were well matched, and the results revealed high adherence rates (90%, 90% and 80% respectively). Results also indicated reductions in pain levels and improvements in function for both intervention groups when compared to the control group. Group A demonstrated better outcomes compared to Group B while Group C showed relatively less improvement. The study concluded a high adherence rate for the three groups as well as a small effect size detected of 0.282 that would suggest a total of 123 participants to be required to replicate the study on a larger scale. With regards to the findings of this pilot, the combination of ESWT and a targeted physical therapy program revealed a possible effective therapeutic approach for plantar fasciitis, with a higher frequency potentially yielding more favourable results.

Principle and design of clinical efficacy observation of extracorporeal cardiac shock wave therapy for patients with myocardial ischemia-reperfusion injury: A prospective randomized controlled trial protocol

Background Acute ST-segment elevation myocardial infarction (STEMI) remains a serious life threatening event with a poor prognosis due to myocardial ischemia/reperfusion injury despite coronary revascularization. Extracorporeal cardiac shock wave (ECSW) is a safe, effective and non-invasive new method for the treatment of cardiovascular diseases. The current results show that extracorporeal cardiac shock wave provides a new treatment option for patients with severe and advanced coronary heart disease. However, there are relatively few clinical studies on the application of in vitro cardiac shock waves in patients with myocardial ischemia-reperfusion injury. We hypothesized that extracorporeal cardiac shock therapy would also be effective in reducing clinical endpoints in patients with STEMI reperfusion. Objective This study is order to provide a new therapeutic method for patients with myocardial ischemia-reperfusion injury and reveal the possible mechanism of ECSW for ischemia-reperfusion injury. Methods and materials CEECSWIIRI is a single-center, prospective randomized controlled trial that plans to enroll 102 eligible patients with acute ST-segment elevation myocardial infarction reperfusion. Eligible patients with STEMI reperfusion will be randomly divided into external cardiac shock therapy (ECSW) trial group and blank control group. The blank control group will receive optimal drug therapy, and the experimental group will receive optimal drug therapy combined with ECSW. The shock wave treatment plan will be 3-month therapy, specifically 1 week of treatment per month, 3 weeks of rest, 3 times of ECSW in each treatment week, respectively on the first day, the third day and the fifth day of the treatment week, lasting for 3 months and follow-up for 2 years. The primary endpoint will be to assess the 2-year improvement in all-cause death, re-hospitalization due to cardiovascular disease, major unintentional cerebrovascular events, including cardiogenic death, myocardial infarction, heart failure, arrhythmia, emergency coronary revascularization, and stroke in patients with STEMI reperfusion. Secondary endpoints will include improvements in angina pectoris, quality of life, cardiac structure and function, coronary microcirculation, and endothelial progenitor cell-derived miR-140-3p in relation to survival outcomes. Trial registration number ClinicalTrial.gov.org PRS:NCT05624203; Date of registration: November 12, 2022.

Effects of Extracorporeal Shock Wave Therapy in Patients with Mild-to-Moderate Carpal Tunnel Syndrome: An Updated Systematic Review with Meta-Analysis

Background: Carpal tunnel syndrome (CTS) is the most common entrapment syndrome, primarily affecting women between the ages of 40 and 70, and conservative treatments are the first option for mild-to-moderate CTS. However, the comparisons between extracorporeal shock wave therapy (ESWT) and other non-surgical methods in the treatment of mild-to-moderate CTS remain controversial, and an updated systematic review is needed. Methods: An electronic search was performed, and all available articles until August 2023 were included in the analysis. The overall quality of evidence was assessed by the GRADE approach. Meta-analyses were conducted using Manager V.5.3.3. Pooled effect sizes were expressed as the weighted mean difference (WMD) with 95% confidence intervals (CIs). Results: A total of 19 RCTs were included. Low-level quality evidence showed that ESWT outperformed the control intervention in terms of functional improvements, pain relief, electrodiagnostic parameters, and cross-sectional area of the median nerve at any time point of follow-up. Compared to local corticosteroid injection (LCI), there were statistically better improvements in functional improvements, pain relief, and electrodiagnostic parameters at 3 and 6 months of follow-up. Conclusions: There is low-level quality evidence to show that both fESWT and rESWT are more clinically effective than controls in symptom relief, functional enhancement, and electrophysiologic parameters’ improvement for patients with mild-to-moderate CTS at any time point of follow-up. Compared with LCI, ESWT yielded similar short-term (&lt;1 month) but better medium- (1–6 months) and long-term (&gt;6 months) improvements in pain relief and functional recovery with fewer potential complications.

Effect of eccentric exercise and shock wave therapy in patients with Achilles tendinopathy – a review of the literature

Aim of study. The purpose of this study was to evaluate the effectiveness of training using eccentric exercises and shock wave therapy in people with Achilles tendinopathy. Material and methods. The available literature was analyzed based on English-language databases PubMed, Scopus, ScienceDirect, Medline and others, using the Google Scholar search engine. Twenty articles were analyzed out of 120 retrieved by the above method. Publications published up to 24/09/2023 were used, using the following keywords: Achilles tendinopathy, physiotherapy, shock wave, Alfredson protocol, eccentric exercises. Results: After analyzing the papers, it was noted that eccentric exercises based on the Alfredson protocol are effective in the treatment of Achilles tendinopathy. Shock wave therapy appears to be a mostly safe and effective form of treatment. Conclusions. Contemporary research indicates that conservative treatment methods in the form of eccentric exercises and shock wave therapy appear to be effective in the treatment of Achilles tendinopathy. Although studies on the effectiveness of using shock wave therapy are of low quality for the most part, it appears to be a safe and effective form of treatment for Achilles tendinopathy.

Comparison of the Clinical Efficacy of Arthroscopic Surgery and Extracorporeal Shock Wave Therapy in the Treatment of Knee Osteoarthritis

This paper aims to explore the clinical efficacy of arthroscopic surgery and extracorporeal shock wave therapy in patients with knee osteoarthritis. The research period was from February 2022 to January 2023. A total of 79 patients with knee osteoarthritis were included and divided into the study group (n = 40) and the control group (n = 39) by lottery method using computer software. The patients in the control group were treated with arthroscopic surgery, and the patients in the study group were treated with extracorporeal shock wave therapy. The Lysholm score, visual analogue scale (VAS) score, Western Ontario and McMaster University Osteoarthritis (WOMAC) score, superoxide dismutase (SOD) level, and malondialdehyde (MDA) level were compared between the two groups. After treatment, the Lysholm score of the study group was higher than that of the control group, and the VAS score and WOMAC score were lower than those of the control group (P &lt; 0.05). While the MDA level of the study group was lower than that of the control group, and the SOD level was higher than that of the control group (P &lt; 0.05). Extracorporeal shock wave therapy for patients with knee osteoarthritis can restore joint function, relieve pain, and effectively regulate the level of oxygen free radicals.

The role of magnetic resonance imaging in efficacy of low-dose extracorporeal shock wave therapy for patients with knee osteoarthritis

Among many diseases of the joints, the most common is osteoarthritis and, in particular, knee osteoarthritis. Current medicine requires new and improved imaging techniques to assess patients with knee osteoarthritis, which enable early diagnosis, improved understanding of the pathophysiology of osteoarthritis, and the efficacy of the ongoing treatment. Scientific data on the use of magnetic resonance imaging (MRI) as an objective method to assess the impact of shock wave therapy (SWT) on the restoration of damaged cartilage and bone marrow in patients with knee osteoarthritis was analyzed. A search for publications in the PEDro and PubMed databases for the period from 2017 to 2022 was performed. The search was done using the following keywords: osteoarthritis/knee osteoarthritis, shock wave therapy, magnetic resonance imaging. Five foreign studies were included in the review as a result of the search (no Russian publications were available). Two studies analyzed the effects of SWT on altered cartilage in patients with knee osteoarthritis. Patients who received oral non-steroidal anti-inflammatory drugs were selected as a comparison group. The authors assessed SWT effects on cartilage using quantitative estimates of T2 relaxation time (T2 mapping) and the severity of bone marrow edema on MRI images. At 24 weeks after treatment, differences in relaxation time on T2-weighted MRI images of the patella, acetabulum, and medial and lateral articular surfaces of the femur and tibia showed no statistical significance compared to those before treatment (t= 1.859; P= 0.076). In conclusion, the authors suggested that the resulting effect of SWT in patients with knee osteoarthritis was due to the use of low energy and stated that research will continue using higher SWT parameters. Another study reported that patients with knee osteoarthritis showed a statistically significant reduction in the area of the subchondral bone marrow lesion 6 months after SWT. In addition, the authors found a correlation between the reduction in subchondral bone marrow lesion size and the improvement in pain scores resulting from the SWT treatment. In another study, MRI scans in patients with knee osteoarthritis documented a positive SWT effect by reducing bone marrow edema. After one year of follow-up, MRI images showed complete regression of bone marrow edema among patients who received SWT. The number of studies that investigated SWT effects on cartilage and bone marrow restoration in patients with knee osteoarthritis using MRI is limited, indicating the need for continued research in this area.

(053) Low Intensity Shockwave Therapy in Patients with Vulvas with Sexual Dysfunction

Abstract Introduction High intensity shockwave treatment has been used for kidney stone lithotripsy since the 1980’s; such devices generate an energy flux density (EFD) of approximately 0.9 mJ/mm2. Low intensity shockwave therapy (LiSWT) devices generate approximately one tenth of that EFD, 0.05 – 0.13 mJ/mm2. LiSWT was first used in sexual medicine in 2010 to treat erectile dysfunction (ED). In 2019 we began utilizing LiSWT for patients with vulvas with various sexual dysfunctions (SD). Objective To review our clinical uses of LiSWT as a non-hormonal, non-surgical treatment option for individuals with vulvas with various complaints of SD. Methods We have performed 324 total LiSWT treatment sessions, 1 to 17 total treatments per person, in 77 individuals with vulvas with SD; EFD (0.05 – 0.13 mJ/mm2), shocks (1800 – 4000/treatment), Hz 3, membrane pressure 1. The specific device used in our clinic, Softwave (TRT), is considered non-significant risk for human use by the FDA and cleared for pain amelioration, connective tissue activation, wound healing, and improved blood flow. This device has a parabolic reflective surface. For each underwater spark-gap discharge that generates a shockwave, there actually two shockwaves delivered: a primary unfocused shockwave and a secondary reflected focused shockwave. Each energy wave induces a variety of biologic reactions in tissues resulting from the mechanotransduction contraction/expansion forces produced. Results To date we have identified 4 clinical uses for LiSWT in our patients with vulvas (mean age 39 ± 21 years). Individuals with hormonally-mediated vestibulodynia (n = 12) or entrance dyspareunia associated with genitourinary syndrome of menopause (n = 13) have received a total of 61 (mean 5) and 64 (mean 5) vestibular treatment sessions, respectively. Positive outcomes from a sham-controlled randomized trial have been published for vestibulodynia. Our positive clinical experience in 60% (15/25) mirrors their data. This is especially important because not everyone is willing or able to undergo hormone treatment. Individuals with genito-pelvic dysesthesia from sacral radiculopathy (n = 22) have received 109 (mean 5) treatments directed to their lumbo-sacral region. These patients were either not candidates for spine surgery or continued to experience mild symptoms after spine surgery. LiSWT decreased or eliminated dysesthesia symptoms in 68% (15/22); a key predictor of success was the activation of radiculopathy symptoms (e.g. feet burning) during treatment. Finally, individuals who underwent LiSWT pre-operatively to reduce opioid use after complete vestibulectomy (n = 30) have received 90 (mean 3) vestibular treatments with a 65% reduction in opioid use with such prophylactic treatment. We have observed no serious and 2 transient adverse events, mild discomfort that resolved within several hours. Conclusions For individuals with vulvas with varying complaints of SD, LiSWT is a safe and effective non-hormonal, non-surgical treatment strategy. More research with LiSWT in this population is needed. A potential new clinical use for LiSWT is to manage stress/urge urinary incontinence (SUI) in a non-invasive, non-pharmacologic strategy. Disclosure No

Comparison of the Effectiveness of Local Corticosteroid Injection and Extracorporeal Shockwave Therapy in Patients With Pes Anserine Bursitis: An Open-Label Randomized Clinical Trial.

Background: The success rate of extracorporeal shock wave therapy (ESWT) in treating epicondylitis, plantar fasciitis, rotator cuff tendonitis, Achilles tendonitis, and Jumper knee has been reported to be 60% to 80%. Most published studies have compared focused ESWT at different intensities with local corticosteroid injection (LCI). We only identified a few studies that specifically compared ESWT with LCI in patients with pes anserine bursitis (PAB). This study aimed to compare the effectiveness of ESWT and LCI in patients with PAB. Methods: The present study was a randomized clinical trial. Patients diagnosed with PAB who were referred to the physical medicine and rehabilitation clinic underwent a complete physical examination. They (n = 60 patients) were randomly assigned to the ESWT and LCI groups if they met the study criteria. In the ESWT group, 1 ESWT session was performed weekly for 3 consecutive weeks. In the LCI group, 1 injection was performed under an ultrasonography guide. Pes anserine thickness, pain intensity, and treatment satisfaction were measured with visual analog scale (VAS) and quality of life (Short Form-12). A paired-samples t test was used to compare the results obtained in the pre-and posttests. Analysis of variance for repeated measures was used to detect differences over time. The null hypothesis would not be confirmed if the P value was less than the 0.05 level of significance. Results: Pes anserine thickness and pain intensity decreased significantly during the study in both groups (P < 0.001). However, the mean difference of pes anserine thickness was more in the LCI group the ESWT group [(-0.6; 95% CI, -1.0 to -0.3) than (-0.1; 95% CI, -0.5, -0.2); P = 0.008]. Also, the mean difference of pain intensity was lower in the ESWT group] than the LCI group [(-2.9; 95% CI, -3.7 to -2.1) (1.0; 95% CI, 0.1to 1.8); P < 0.001]. Patients' quality of life in both groups increased significantly during the study period (P < 0.001), but the increase in quality of life in patients in the ESWT group (mean difference, 15.3 [95% CI, 10.6-19.9]) was considerably more than in the LCI group (mean difference, -5.3 (95% CI, -10.0 to -0.6). Conclusion: Overall, the results of this study showed that both local corticosteroid injections and extracorporeal shock wave therapy are safe and effective in PAB patients.

Shock Wave Therapy in Patients with Erectile Dysfunction

Erectile dysfunction is a serious medical problem because it directly affects the sex life of a man, but it also has an overall effect on his self-esteem and social behaviour.&#x0D; Pathophysiologically, erectile dysfunction may be due to factors of vascular origin, anatomical and structural features, neurological disorders, hormonal problems, drug-induced disorders, or iatrogenic trauma. The so-called psychogenic erectile dysfunction is not uncommon. In addition to the establishedtherapy with phosphodiesterase inhibitors, there are a number of publications that focus on the effect of Shock wave therapy as an alternative for treating erectile dysfunction. However, this issue remains debatable. Extracorporeal shockwave therapy is used as a method of treating erection problems, as itinduces neovascularization and improves blood flow to the cavernous tissue.&#x0D; Our goal is to test the efficacy and safety of Shock Wave therapy and to determine its place in the treatment of patients with erectile dysfunction.&#x0D; Clinical follow-up included 120 men between the ages of 30 and 75 (mean 55.68) diagnosed with erectile dysfunction. Patients were treated and monitored for a period of two years (January 2017 to April 2019). Detailed anamnestic data was taken, including sexual history, and full laboratory tests were performed.We used the following questionnaires to evaluate the extent of erectile dysfunction: International Index of Erectile Function (IIEF-5), Erection Hardness Score (EHS). All patients underwent shockwave therapy. Course duration was ten weeks, one procedure per week. Extracorporeal shock wave therapy equipment (BTL-5000) was used.&#x0D; With regard to the Erection Hardness Score (EHS), there was a significant improvement in penis firmness, immediately after the first procedure, which persisted after the end of treatment until the third month after therapy. Improvement in firmness was mainly observed in patients with moderate and mild erectile dysfunction, while no significant improvement was observed in patients with complete inability to achieve erection.&#x0D; With respect to the International Index of Erectile Function (IIEF-5), there is a significant improvement in erectile function, mainly in the groups with mild and moderate erectile dysfunction. The effect of therapy is maintained until the third month of treatment. No improvement in the condition was observed in patients with severe erectile dysfunction.&#x0D; The mean value of IIEF-5 increased significantly from 14.54 to 18.85 after the end of treatment, and this value was sustained until the third month after the treatment – 18.55. The procedure was well tolerated by patients, with no side effects reported during and after the procedure.&#x0D; The developments in modern technology and in the pharmaceutical industry have fundamentally changed the understanding of erectile dysfunction and the methods of treating it. More and more young people are rejecting the continued use of medication and looking for an alternative to effective treatment. Thus, there is a need for new methods of treating patients with erectile dysfunction. Based on publications in world literature, and on our own results, we have come to the conclusion that extracorporeal shock wave therapy may be an alternative to therapy with Phosphodiesterase 5 inhibitors (PDE5). Following the course of treatment, there was a significant increase in the number of patients without erectile dysfunction, and an increase in the total IIEF-5 score from 14.54 before treatment to 18.55 3 months after the end of therapy. This confirms the assumption of a lasting effect of the therapy 3 months after the end of treatment.

Evaluation of the Effects of Extracorporeal Shockwave Therapy in Patients With Peripheral Arterial Disease: A Meta-Analysis of Randomized Control Trials.

The aim of this meta-analysis is to assess the efficacyof extracorporeal shockwave therapy (ESWT) in patients with peripheral arterial disease (PAD).This meta-analysis was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A systematic search was conducted independently by two authors using PubMed, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL) from inception to January 15, 2023. Primary clinical outcomes assessed in this meta-analysis were changes in maximum waking distance (MWD) and pain-free walking distance (PFWD) from baseline. Other outcomes assessed included change in ankle brachial pressure index (ABI) and degree of arterial stenosis. Four RCTs involving a total of 228 patients were included. Change ofPFWD and MWD from baseline was significantly higher in patients randomized in the ESWT group as compared to the control group. No significant differences were reported between the two groups in terms of change in ABI from baseline. In conclusion, this meta-analysis of four randomized controlled trials found evidence that ESWTis an effective treatment for patients with PAD in terms ofimproving PFWD and MWD and reducing stenosis. However, there was no significant difference in the improvement of the ankle-brachial index between the study groups.

Observation of the effectiveness of clinical indicators of cardiac shock wave therapy in patients with ischemic heart disease: A systematic review and meta-analysis.

Ischemic heart disease (IHD) has a high prevalence and mortality rate, imposing a heavy burden on patients and society, and there is still a need to optimize treatment options for IHD patients. Cardiac shock wave therapy (CSWT) is gaining popularity as a new treatment for IHD patients. The objective of this meta-analysis is to reassess the effects of CSWT on IHD patients in light of the limited number of clinical studies included in previously published reviews, inconsistent methodological quality, and unclear outcomes. From database creation until September 1, 2022, 4 English databases and 3 Chinese databases were rigorously searched for any current controlled trials of CSWT for IHD. The Cochrane Risk of Bias Assessment Tool was used for methodological quality assessment. Review Manager v.5.4 software was used for meta-analysis. Nineteen published controlled trials totaling 1,254 subjects were included. Results showed that CSWT could enhance left ventricular function and myocardial viability, improve cardiac function and alleviate angina pectoris symptoms. The effects of CSWT and control groups on SAQ scores and exercise time were not statistically significant. According to this systematic review and meta-analysis, CSWT may be beneficial for a number of IHD clinical indications. To verify these findings, more RCT studies with bigger sample numbers and higher methodological standards are required in the future.

Safety and efficacy of direct cardiac shockwave therapy in patients with ischemic cardiomyopathy undergoing coronary artery bypass grafting (the CAST-HF trial): study protocol for a randomized controlled trial—an update

Coronary artery disease (CAD) remains a severe socio-economic burden in the Western world. Coronary obstruction and subsequent myocardial ischemia result in the progressive replacement of contractile myocardium with dysfunctional, fibrotic scar tissue. Post-infarctional remodelling is causal for the concomitant decline of left-ventricular function and the fatal syndrome of heart failure. Available neurohumoral treatment strategies aim at the improvement of symptoms. Despite extensive research, therapeutic options for myocardial regeneration, including (stem)-cell therapy, gene therapy, cellular reprogramming or tissue engineering, remain purely experimental. Thus, there is an urgent clinical need for novel treatment options for inducing myocardial regeneration and improving left-ventricular function in ischemic cardiomyopathy. Shockwave therapy (SWT) is a well-established regenerative tool that is effective for the treatment of chronic tendonitis, long-bone non-union and wound-healing disorders. In preclinical trials, SWT regenerated ischemic myocardium via the induction of angiogenesis and the reduction of fibrotic scar tissue, resulting in improved left-ventricular function. In this prospective, randomized controlled, single-blind, monocentric study, 80 patients with reduced left-ventricular ejection fraction (LVEF≤ 40%) are subjected to coronary-artery bypass-graft surgery (CABG) surgery and randomized in a 1:1 ratio to receive additional cardiac SWT (intervention group; 40 patients) or CABG surgery with sham treatment (control group; 40 patients). This study aims to evaluate (1) the safety and (2) the efficacy of cardiac SWT as adjunctive treatment during CABG surgery for the regeneration of ischemic myocardium. The primary endpoints of the study represent (1) major cardiac events and (2) changes in left-ventricular function 12 months after treatment. Secondary endpoints include 6-min walk test distance, improvement of symptoms and assessment of quality of life. This study aims to investigate the safety and efficacy of cardiac SWT during CABG surgery for myocardial regeneration. The induction of angiogenesis, decrease of fibrotic scar tissue formation and, thus, improvement of left-ventricular function could lead to improved quality of life and prognosis for patients with ischemic heart failure. Thus, it could become the first clinically available treatment strategy for the regeneration of ischemic myocardium alleviating the socio-economic burden of heart failure. ClinicalTrials.gov NCT03859466. Registered on 1 March 2019.

Efficacy and safety of cardiac shock wave therapy for patients with severe coronary artery disease: A randomized, double-blind control study

BackgroundPrevious studies proved the efficacy of cardiac shock wave therapy (CSWT) for coronary artery disease (CAD) patients who are not candidate for reperfusion therapy. Randomized control trials are limited. We try to explore the efficacy and safety of CSWT for patients with severe CAD. MethodsThirty patients with severe CAD who had obvious ischemia on myocardial perfusion imaging (MPI) were enrolled and randomly assigned to the CSWT group or the control group. They had received optimal medication treatment for at least three months. Nine sessions of shock wave therapy were conducted over 3 months. CSWT group received the real treatment, while the control group received the pseudo-treatment. Clinical symptom, imaging outcomes and safety parameters were compared between two groups. ResultsAfter treatment, regional stress score (P = .023), improvement rate (IR) of ischemic area (IA) stress (P < .001) and IR of IA difference (P < .001) were significantly favor CSWT group. The interaction of summed rest score (P < .001), summed stress score (P = .004), summed difference score (P = .036) were significantly improved in the CSWT group compared to the control group. Seattle angina questionnaire, quality of life (QOL) and the distance of six-minute walking test (6MWT) were improved in both groups without significant difference between them. Hemodynamic parameters were stable during procedure. Myocardial injury markers showed no changes in two groups. ConclusionsOur study demonstrated CSWT could effectively and safely improve myocardial perfusion in patients with severe CAD. Clinical symptom, QOL and 6MWT were all improved after treatment, but no significant difference between two groups.

Effect of Extra-corporeal Shock-wave Therapy in the Management of Chronic Plantar Fasciitis

Plantar fasciitis is a progressive degenerative condition of the plantar fascia which is reported to be one of the most common causes of lower heel pain in adults. Extracorporeal Shock Wave Therapy is being used for the management of plantar fasciitis now a day. The aim of the study was to find out the effects of Extracorporeal Shock-wave therapy in patients with chronic plantar fasciitis. A randomized clinical trial was conducted from May to October 2015, on 60 patients aged more than 18 years with plantar fasciitis attending in the department of Physical Medicine and Rehabilitation (PMR) in the Dhaka Medical College Hospital (DMCH) to observe the effectiveness of Extracorporeal shock-wave therapy (ESWT) in the treatment of plantar fasciitis and its therapeutic outcomes.60 patients were allocated randomly into intervention group (Group A) and control group (Group B). Data were composed through face to face interview using a questionnaire based on 1.Visual analogue scale, 2.Modified Roles and Maudsley score, and 3.100-point Scoring System for Plantar Fasciitis. But after 8 weeks, score was found lower in Group A than Group B (p&lt;0.05).The usual total pain score was higher in 100-point Scoring System for Plantar Fasciitis (p&lt;0.001) after 8 weeks of treatment as well average function score (0.001) in Group A. Patient satisfaction was also found higher in Group A by using Modified Roles and Maudsley score. Extracorporeal shock-wave therapy showed effective, so it can be suggested for the patients. Bangladesh Med J. 2021 May; 50(2) : 1-8

Comparison of Plantar Pressure Distribution and Ultrasonographic and Clinical Features After Application of Different Energy Levels of Extracorporeal Shockwave Therapy in Patients with Plantar Fasciitis: A Randomized, Prospective, Double-Blind Clinical Trial.

The effectiveness of different energy levels used in extracorporeal shockwave therapy (ESWT) has been investigated in previous studies, but controversy remains regarding which energy levels should be used in the treatment of plantar fasciitis. We compared the efficacy of different energy levels used in ESWT in the treatment of plantar fasciitis using plantar fascia thickness and pressure distribution. Between July 2021 and September 2021, a total of 51 patients (71 feet) with plantar fasciitis were randomized into three treatment groups using the sealed envelope method. Group 1 (n = 25) received low energy density (0.09 mJ/mm2), group 2 (n = 25) received medium energy density (0.18 mJ/mm2), and group 3 (n = 21) received high energy density (0.38 mJ/mm2). Each group received three sessions of ESWT at a frequency of 2,000 shocks per minute at 1-week intervals. Patients were evaluated before and after treatment using a visual analog scale (VAS) for pain, the Foot Function Index (FFI), plantar fascia thickness measured by ultrasonography, and plantar pressure distribution. Posttreatment VAS and FFI scores were determined to be significantly lower than the values before treatment in the three groups (P < .001). There were no significant differences among groups in pretreatment and posttreatment values of VAS, FFI, plantar fascia thickness, and pressure distribution (P > .05). No significant differences were found among groups in percentage changes in all of the outcome parameters (P > .05). There was no superiority among low, medium, or high levels of ESWT in terms of pain, foot functions, fascia thickness, and pressure distribution in the treatment of plantar fasciitis.

Efficacy and Effectiveness of Extracorporeal Shockwave Therapy in Patients with Myofascial Pain or Fibromyalgia: A Scoping Review.

Myofascial pain syndrome (MPS) and fibromyalgia (FM) are underestimated painful musculoskeletal conditions that could impact function and quality of life. A consensus about the most appropriate therapeutic approach is still not reached. Considering the long course of the diseases, prolonged assumption of drugs, such as NSAIDs and pain killers, could increase the risk of adverse events, often leading affected patients and physicians to prefer non-pharmacological approaches. Among these, radial and focused extracorporeal shock waves therapies (ESWT) are widely used in the management of painful musculoskeletal conditions, despite the fact that the mechanisms of action in the context of pain modulation should be further clarified. We performed a scoping review on PubMed using Mesh terms for analyzing the current evidence about the efficacy and effectiveness of ESWT for patients with MPS or FM. We included 19 clinical studies (randomized controlled trials and observational studies); 12 used radial ESWT, and 7 used focused ESWT for MPS. Qualitative analysis suggests a beneficial role of ESWT for improving clinical and functional outcomes in people with MPS, whereas no evidence was found for FM. Considering this research gap, we finally suggested a therapeutic protocol for this latter condition according to the most recent diagnostic criteria.

Эндоваскулярная окклюзия в комбинированном лечении артериовенозной эректильной дисфункции

BACKGROUND: The vasculogenic nature of the erectile dysfunction (ED) prevails over other causes and accounts for 70%, of which 30% is arteriogenic, 20% to 40% is venogenic, and 30% is mixed arteriovenous ED. The main importance of shock wave therapy (SWT) in the treatment of ED is a complex positive effect on the blood supply of the penis. However, there is not enough information in the literature about the use of SWT in patients with arteriovenous ED, which determines the relevance of research in this direction. AIM: To evaluate the results of combined treatment (SWT and endovascular embolization of the deep dorsal vein (DDV) of the penis) in patients with arteriovenous ED. MATERIALS AND METHODS: In the Federal State Research Center of the Federal Medical and Biomedical Agency named after AI Burnazyan of Russia 45 patients aged 26 to 45 years (35.5 ± 9.5) years with a confirmed clinical diagnosis of arteriovenous ED, who underwent combined treatment were examined. The treatment was performed in 2 stages: stage I included endovascular embolization of the dorsal penile vein; stage II consisted of SWT with the use of BTL-6000 SWT TOPLINE device (BTL Corporate) in 2 weeks after surgical treatment. The condition of patients was assessed before treatment and 1 and 12 months after it. The assessment was based on the data of the questionnaire of the International Index of Erectile Function, fifth revision (IIEF-5), and the Erection Rigidity Scale (ESR), as well as instrumental diagnostic methods: computer dynamic cavernosography and pharmacodoplerography. RESULTS: An improvement of blood flow velocity parameters, a positive dynamic according to IIEF-5 and SER in 1 year following treatment. CONCLUSIONS: The use of endovascular occlusion in combination with SWT is the correct method of treatment for arteriovenous ED, but still requires further study.

Effect and Optimal Timing of Extracorporeal Shock-Wave Intervention to Patients With Spasticity After Stroke: A Systematic Review and Meta-analysis.

This study investigated the efficacy of extracorporeal shock wave therapy as well as the optimal intervention timing for extracorporeal shock wave therapy for patients with spasticity after stroke. A search of randomized controlled trials was conducted in different electronic databases. We performed a meta-analysis to measure the effect of extracorporeal shock wave therapy versus sham interventions on spasticity and limb functionality. The meta-regression analysis was performed to determine the adequate intervention timing of extracorporeal shock wave therapy. The follow-up period of the outcomes was divided into the short (<2 wks), mid (>2 wks and ≤4 wks), and long (>4 wks and ≤3 mos) terms. Thirteen studies with 677 participants were evaluated. Spasticity significantly improved throughout the follow-up duration. Limb functionality significantly improved in the short-term follow-up period. The meta-regression analysis showed that patients with stroke duration less than 45 mos may be benefited from extracorporeal shock wave therapy in improving limb function in all follow-up periods. Extracorporeal shock wave therapy is an effective method for reducing spasticity in patients with stroke, and the effect could be maintained for up to 3 mos. Its effects on limb functionality could persist for at least 2 wks. Patients who had stroke for less than 45 mos may have significant benefit from extracorporeal shock wave therapy in all follow-up periods.

The impact of extracorporeal shock wave therapy on pain, grip strength and functionality in patients with medial epicondylitis and lateral epicondylitis efficacy of extracorporeal shock wave therapy in patients with epicondylitis

The impact of extracorporeal shock wave therapy on pain, grip strength and functionality in patients with medial epicondylitis and lateral epicondylitis efficacy of extracorporeal shock wave therapy in patients with epicondylitis