Use Of Extracorporeal Shock Wave Therapy Research Articles

The effect of extracorporeal shock-wave therapy on pain in patients with various tendinopathies: a systematic review and meta-analysis of randomized control trials

ObjectivesTendinopathy is a common condition that affects the body’s tendon structures, causing discomfort, restricted movement, and reduced functionality. In this study, we looked at how extracorporeal shock wave therapy (ESWT) affected pain levels in individuals with various forms of tendinopathy around the world.DesignThis study is a comprehensive review and meta-analysis of previously published randomized controlled trials. To gather relevant data, the researchers performed keyword searches in international databases, including PubMed (Medline), Scopus, Web of Sciences, Cochrane Central Register of Controlled Trials (CENTRAL), Research Registers of ongoing trials (ClinicalTrials.gov), as well as Embase. The search was conducted up until March 2023. The quality of the selected articles was assessed using the Cochrane risk-of-bias method for randomized trials (RoB2).ResultsBased on the results of the meta-analysis, which included 45 clinical studies, the use of ESWT was found to have a significant impact on reducing pain in various conditions. The standardized mean difference (SMD) in patients with plantar fasciitis (PF) was reduced by 1.63 (SMD: -1.63, 95% CI: -3.04, -0.21; I2: 77.36%; P heterogeneity: 0.0001). For lateral epicondylitis (LE), the SMD was 0.63 (SMD: -0.63, 95% CI: -1.11, -0.16; I2: 67.50%; P heterogeneity: 0.003). In the case of chronic Achilles tendinopathy, the SMD was 1.38 (SMD: -1.38, 95% CI: -1.66, -1.10; I2: 96.44%; P heterogeneity: 0.0001). Additionally, in individuals with rotator cuff tendinopathy, the SMD for pain reduction was 2.37 units (SMD: -2.37, 95% CI: -3.58, -1.15; I2: 98.46%; P heterogeneity: 0.0001).ConclusionThis study suggests that ESWT can be a highly effective therapy option for relieving pain in people with tendinopathy. Nonetheless, it is encouraged to make additional recommendations based on high-quality clinical research and more accurate information in order to define the optimal therapeutic options for each type of tendinopathy.

Iliotibial Band Syndrome Current Evidence

Abstract Purpose of Review The goal of this paper was to synthesize the most up-to-date information on iliotibial band syndrome (ITBS). Recent Findings Progression of running volume was not more significantly associated with ITBS incidence than progression of running intensity. Functional motor control exercises may be superior to traditional exercise. ESWT (extracorporeal shockwave therapy) is shown to be an effective treatment for ITBS. Summary ITBS has the second-highest incidence rate of all knee pathologies in runners. The pathophysiology of ITBS is still unknown as recent studies have shown the original theory that the disease is caused by friction between the ITB and lateral femoral epicondyle is unlikely. Conservative management continues to be the main course of treatment for ITBS. Different exercise programs may yield different results, but a consistent program typically results in improvement of symptoms. More studies are required to evaluate the effectiveness of alternative therapies. Recent studies support the use of ESWT for the treatment of ITBS.

Use of extracorporeal shockwave therapies for athletes and physically active individuals: a systematic review

ObjectiveTo determine the efficacy of extracorporeal shockwave therapy (ESWT) and investigate outcomes following the use of ESWT for athletes and physically active individuals.DesignSystematic review.Data sourcesWe followed the Preferred Reporting Items...

The effectiveness of Extracorporeal Shockwave Therapy in the treatment of chronic low back pain

Introduction: Low back pain is the most prevalent chronic pain syndrome in clinical practice. Due to safer benefits, nonpharmacological, exercise-based treatments represent the first choice for chronic low back pain (CLBP). Recently, Extracorporeal Shockwave Therapy (ESWT) has been suggested as a new treatment option for CLBP. The aim was to provide an overview of the effectiveness of ESWT in combination with exercise versus exercise alone in pain and disability reduction in CLBP through a systematic review of published randomised control trials (RCTs). Methods: Original RCTs related to the use of ESWT in CLBP were searched in PubMed, Cochrane’s library and the Physiotherapy Evidence Database back ten years from January 2023. The recommendations of the Preferred Reporting Items for Systematic Review and MetaAnalysis statement and The Prisma in Exercise, Rehabilitation, Sport Medicine and SporTs scientific guidance were followed. Data on study information, Population characteristics, Intervention treatment, Control or comparators, and Outcomes were extracted. Outcomes of primary interest were pain and disability, observed before and after treatments. The results are presented systematically and narratively. Results and Discussion: Two eligible RCTs were included from the initial 30 identified. Despite the evident reduction in pain and disability in the ESWT groups, the significance of the outcome versus the control groups in the short and long-term periods is conflicting between studies. Conclusion: In treating CLBP, ESWT combined with exercises is to some extent clinically superior to exercises alone; however, evidence should be used with caution due to the lack of studies and existing confrontations.

The Role of Extracorporeal Shock Wave Therapy in the Treatment of Muscle Injuries: A Systematic Review.

Muscle injuries commonly occur in sports and can be classified as indirect and direct, according to the 2013 Munich Consensus Statement (MCS). Since recent evidence suggests that extracorporeal shock wave therapy (ESWT) improves muscular microcirculation and may increaseregenerationafter acute muscle injury, we performed a systematic review following the Preferred Reporting Items forSystematicReviews and Meta-Analyses (PRISMA) statement guidelines to access the efficacy and safety of ESWT in the treatment of patients with muscle injuries. PubMed and Cochrane were searched to screen for potentially relevant articles and the literature search was last updated in June 2023. The inclusion criteria were randomized controlled trials, observational studies, or case controls published in English, Portuguese, or Spanish that studied the effect of ESWT on indirect and direct muscle injuries in individuals aged ≥18, with at least one of the following reported outcomes: pain on the visual analogscale (VAS), functionality assessed either with disability scales or subjectively, time for return to play (RTP), re-injury rate, and ultrasonographic evaluation. The exclusion criteria were literature reviews, systematic reviews, studies in animals, studies in other languages, studies that failed to meet the targeted population or intervention and studies that didn't report any of the outcomes of interest. The quality of the studies was analyzed using the Cochrane Assessment Tool, the Newcastle-Ottawa Quality Assessment Scale, and the JBI Critical Appraisal Checklist. Eight studies were included in the systematic review (two randomized controlled trials, one prospective observational study, two retrospective observational studies, and three case reports), with a total of 143 adult participants. ESWT was associated with less pain on VAS, better function, reduction of size of lesion on ultrasound evaluation, faster RTP and/or lower re-injury rate in patients with indirect and direct muscle injuries and muscular hematomas, a frequent secondary complication of muscle injuries. The evidence regarding the use of ESWT for these types of injuries is therefore promising. Nevertheless, higher-quality studies are needed in the future to prove its efficacy, better comprehend its mechanisms of action and define treatment protocols (timing, type and parameters of ESWT).

The use of extracorporeal shock wave therapy (ESWT) in treating osteonecrosis of the femoral head (AVNFH): a retrospective study.

As most of the cases of avascular necrosis (AVN) in Saudi Arabia is seen in young population and as literature showed good effect of extracorporeal shock wave therapy (ESWT) in reducing pain and oedema in avascular necrosis and delaying the need of surgical intervention. Our purpose of this study is to assess the effectiveness of ESWT in reducing pain, improving range of motion (ROM) and delaying the surgical intervention in patient with AVN of femoral head and compare our results to published literature. We have treated 24 patients, 13 males and 11 females with a mean age of 29 years (range 14-48) with 34 hips affected. There were 14 unilateral and ten bilateral lesions. In our series 11 out of 24 patients (45.8%) were due to sickle cell disease. Other causes included idiopathic in five patients (20.8%), corticosteroids use and systemic lupus erythematous in three patients each (12.5% each) and post-traumatic AVN in two patients (8.3%). Extracorporeal shock wave therapy was implanted in FICAT stage I, II and III. All patients had two sessions of extracorporeal shock wave therapy, four to six weeks apart, each with 4000 impulses divided into four points. Radiological and MRI assessment were performed at regular time intervals with a minimum follow-up of two years. Clinical assessment was based on Visual Analog Scale and Harris Hip Score (HHS). The end point outcome measurement was the need for any operative intervention. Operative intervention was necessary in eight out of 34 hips (23.5%), within an average of 2.5 years (range 1 to 5 years). A hip salvage was achieved in 76.5%. Function was improved with the Harris Hip Score from a mean of 54.6 to 80.4 (P value using paired t test ≤ 0.05). Pain assessed with Visual Analog Scale improved from 5.73 to 2.75 (P value using paired t test ≤ 0.05). We do recommend the use of ESWT in treating AVN of bone whether of femoral head or other sites prior to the collapse of the articular surface. Further studies are needed to compare using two or more sessions as well as using four or six points for ESWT.

Outcomes Using Focused Shockwave for Treatment of Bone Stress Injury in Runners.

Bone stress injury (BSI) is a common overuse injury that can result in prolonged time away from sport. Limited studies have characterized the use of extracorporeal shockwave therapy (ESWT) for the treatment of BSI. The purpose of this study was to describe the use of ESWT for the management of BSI in runners. A retrospective chart review was performed to identify eligible patients in a single physician's clinic from 1 August 2018 to 30 September 2022. BSI was identified in 40 runners with 41 injuries (28 females; average age and standard deviation: 30 ± 13 years; average pre-injury training 72 ± 40 km per week). Overall, 63% (n = 26) met the criteria for moderate- or high-risk Female or Male Athlete Triad categories. Runners started ESWT at a median of 36 days (IQR 11 to 95 days; range 3 days to 8 years) from BSI diagnosis. On average, each received 5 ± 2 total focused ESWT treatments. Those with acute BSI (ESWT started <3 months from BSI diagnosis) had an average return to run at 12.0 ± 7.5 weeks, while patients with delayed union (>3 months, n = 3) or non-union (>6 months, n = 9) had longer time for return to running (19.8 ± 14.8 weeks, p = 0.032). All runners returned to pain-free running after ESWT except one runner with non-union of grade 4 navicular BSI who opted for surgery. No complications were observed with ESWT. These findings suggest that focused ESWT may be a safe treatment for the management of BSI in runners.

A Case Series Examining the Use of Extracorporeal Shockwave Therapy (ESWT) to Treat Non-healing Venous Leg Ulcers

With their complex pathogenesis, many wounds, such as venous leg ulcers (VLUs) and diabetic foot ulcers (DFUs), place a significant burden on the global healthcare system [1]. 93% of venous leg ulcers (VLUs) are open for more than a year due to a variety of factors such as comorbidities, lifestyle, and work demands. The most common causes are venous disease, arterial disease, and neuropathy. To avoid inappropriate treatment that could worsen the wound, delay healing, or harm the patient, a correct diagnosis is required. Wound chronicity can lead to complications such as infections, amputation, and even death. The purpose of this study is to determine the efficacy of ESWT therapy in patients with chronic non-healing venous leg ulcers who have not shown any signs of healing for more than a year [2].

Feasibility Using Telehealth for Planning Use of Extracorporeal Shockwave Therapy in a Sports Medicine Clinic.

(1) Background: The purpose of this study is to describe whether telehealth compared with in-person visits, led to a similar agreement of primary diagnosis reached at the time of procedure using extracorporeal shockwave therapy. (2) Methods: This retrospective study consisted of chart reviews of all new patients evaluated in a sports medicine clinic prior to performing extracorporeal shockwave therapy from April 2020 to March 2021. The primary outcome of the study was describing agreement in primary diagnosis at the time of evaluation (telehealth and in-person) and during the procedure using extracorporeal shockwave therapy. Logistic regression was utilized to identify patient characteristics that may predict agreement of diagnosis using telehealth. (3) Results: The chart review identified 166 patients (45 telehealth and 121 in-person) evaluated for extracorporeal shockwave therapy. Agreement of diagnosis was similar for patients evaluated using telehealth compared to in-person visits (84% vs. 92%, Χ2 = 1.90, p = 0.168). Agreement on diagnosis was more likely in patients who started shockwave within the 1 week of initial visit (OR = 8.27, 95% CI = 1.69-45.29), patients over age 60 (OR = 0.94, 95% CI = 0.90-0.99), and in patients without a history of osteoarthritis (OR = 14.00, 95% CI = 1.88-113.46). (4) Conclusions: Telehealth resulted in a similar agreement to in-person visits to identify a primary diagnosis for planning extracorporeal shockwave therapy. Telehealth may be a reasonable alternative to in-person visits for procedural planning of extracorporeal shockwave therapy.

Comparing Extracorporeal Shockwave Therapy (ESWT) with Non ESWT Focused Care on Functional Outcomes in Calcific Tendinopathy of the Shoulder

Purpose: Apatite deposits within tendons are common conditions that may cause pain, loss of motion, and difficulty with function among active individuals. The modality known as Extracorporeal Shockwave Therapy (ESWT) has been utilized successfully in lithotripsy and has been investigated for its possible role in aiding calcification. This literature review aims to look at the state of evidence among previous randomized controlled trials examining the effects of ESWT on calcification within tendons in the upper extremities. Methodology: Extraction Systematic literature searches for randomized controlled trials between 2012-2022 were performed in the databases of PubMed, Academic Search Index, and Directory of Open access Journals, CINAHL, between November 3rd to November 11th, 2022. A total of four randomized controlled trials (full text available, PEDro score &gt; 7, and conducted in the past 10 years) with a total of 238 subjects met methodological quality guidelines using the PEDro scale. Results: A total of 1,042 articles were screened, and 4 studies with a total population of n = 238 were included in the review. With trials using a variety of adjunct therapies and with differences in frequency, dosage, and treatment volume a meta-analysis was not conducted. There were statistically significant improvements reported in terms of pain and function in ESWT on calcific tendinopathy in 1 study (n= 42). On the other hand, non-ESWT clinically significant differences were found in the use of ESWT in 2 of the studies (n=144), and no effects in 0 of the studies (n= 0). A small majority of studies suggest that in the management of tendinopathies of the upper and lower limbs, ESWT has a clinically significant effect on pain and functional outcomes. Conclusion: A review of current randomized controlled trials presented limited evidence for the use of ESWT for upper and lower limb tendinopathies in humans. While the use of ESWT may improve pain and functional outcomes in humans, further studies on dosing, prescription, and risk of bias assessment are suggested. Dr. Baloy has no relevant financial or nonfinancial relationships to disclose. Mr. Becquer has no relevant financial or nonfinancial relationships to disclose. Ms. Obnial has no relevant financial or nonfinancial relationships to disclose. This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

A Comprehensive Review of the Effects of Extracorporeal Shock Wave Therapy on Stroke Patients: Balance, Pain, Spasticity.

Stroke remains a leading cause of disability worldwide, with survivors often experiencing impairments in balance, pain, spasticity, and control that limit their ability to perform daily living activities. Extracorporeal shock wave therapy (ESWT) has emerged as a potential treatment modality to improve these outcomes in stroke patients. This review aims to provide a comprehensive examination of the effects of ESWT on stroke patients, focusing on the theoretical background, balance, pain reduction, muscle spasticity and control, and upper and lower extremities. This study reviewed the use of ESWT in treating balance, pain, and spasticity in stroke patients, focusing on articles published in PubMed between January 2003 and January 2023. Systematic reviews related to stroke were used to provide an overview of stroke, and a total of 33 articles related to balance, pain, and spasticity were selected. ESWT has several shock wave generation methods and application methods, and it has been shown to have positive therapeutic effects on various aspects of rehabilitation for stroke patients, such as improving balance, reducing pain, decreasing muscle spasticity and increasing control, and enhancing functional activities of the upper and lower extremities. The efficacy of ESWT may vary depending on the patient's condition, application method, and treatment area. Therefore, it is important to apply ESWT according to the individual characteristics of each patient in clinical practice to maximize its potential benefits.

The use of extracorporeal shock wave therapy along with other non-drug methods in the treatment of chronic prostatitis from the standpoint of modern evidence-based medicine

Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is one of the most common urogenital pathologies in working men. This disease could significantly negatively affect to the quality of life. The standard drug 3-Astherapy has not a corrective effect in some cases, depending on the phenotype of the disease, other groups of drugs and physiothera-peutic methods of treatment can be used additionally. Currently, the search is underway for the most effective non-drug and drug-based methods of treatment of CP/CPPS. One of these is extracorporeal shock wave therapy (ESWT) and the drug “Longidaza®”. This review analyzes and summarizes the results of large clinical studies evaluating the effectiveness of the use of ESWT in/without combination with drugs, as well as “Longidaza®” in patients with CP/CPPS. The mechanism of action is analyzed in detail and the key effects of the action of ESWT are demonstrated, namely: decrease of pain and dysuria, anti-inflammatory and antibacterial effects, lysis of prostate calcinates and fibrosis.

Clinical Study on the Treatment of Long Bone Fracture Non-Union with Extracorporeal Shock Wave Therapy Combined with Platelet-Rich Plasma

Objective: The objective of the study was to evaluate of the therapeutic efficacy of extracorporeal shock wave therapy (ESWT) combined with platelet-rich plasma (PRP) injection in patients with long bone fracture non-union. Material and Methods: A total of 36 patients identified with long bone fracture non-union treated from September 2020 to September 2023 were enrolled into this study. Employing a random number table method, they were randomly divided into three groups, with 12 cases in each group. Based on the treatment modality, the groups were categorized as the ESWT group, PRP group, and combination ESWT + PRP group. Routine radiographs and musculoskeletal ultrasound were obtained before treatment and at 3-, 6-, and 9-month post-treatment intervals to observe for bone callus formation and assess fracture line imaging scores with the aim to evaluate the treatment efficacy of each group. Results: With the extension of treatment time, the bone callus and fracture line imaging scores of the three groups gradually increased (P &lt; 0.05). At 3-, 6-, and 9-month post-treatment, the scores of the ESWT combined with the PRP group were significantly better than those of the singular ESWT group and PRP group, and the differences were statistically significant (P &lt; 0.05). Conclusion: Therapy with singular ESWT, singular PRP, and combination ESWT + PRP has demonstrated effective improvement in fracture healing for patients with long bone fracture non-union. The synergistic effects of combination therapy were more significant, surpassing the efficacy of singular ESWT or PRP applications. The combined use of ESWT and PRP represents a safe and promising alternative treatment for long-bone fracture non-union, making it a compelling choice in the context of fracture healing. Keywords: Extracorporeal shock wave therapy, Platelet-rich plasma, Non-union of fracture.

Effectiveness of extracorporeal shock wave therapy during the treatment of patients with orthopedic and traumatological upper limbs diseases (literature review)

This method of conservative treatment of orthopedic and traumatological conditions diseases, such as extracorporeal shockwave therapy (ESWT) has been gaining popularity in recent years. Objective. Review modern (for the last 5 years) sourcesof literature on the use of ESWT in the treatment of ortopedotraumatic diseases of the upper limbs. Methods. Publicationsfrom the search system Google, PubMed, Medline and other relevant sources scientific and medical information with the indication of the subject method and the most common orthopedic and traumatological of diseases of the upper limb were analyzed: «ESWT (Extracorporeal Shockwave Therapy) AND fracture», «ESWT AND tendonitis», «ESWT AND subacromial impingement syndrome», «ESWT AND adhesive capsulitis», «ESWT AND frozen schoulder», «ESWT AND trigger finger», «ESWTOR AND lateral epicondylitis», «ESWT AND medial epicondylitis », «ESWT AND ostheoarthritis», «ESWT AND tendinopathy»,«ESWT AND injure». Results. A total of 272 scientific articles were found. The articles related to histological, biomechanicaland experimental studies, wounds, burns and post-stroke changes of the upper limbs, diseases other localizations, as well asmethods of conservative and surgical treatment were excluded. 51 articles were selected for analysis. It was determined thatESWT is used in the treatment of lateral epicondylitis; calcifying tendinitis of muscles shoulder tendinopathies, partial injuriesof rotator cuff muscles of the shoulder; subacromial impingement syndrome; adhesive capsulitis of the shoulder; ununitedfractures and delayed union; navicular bone of the wrist; diseases of the hand (carpal tunnel syndrome, snapping finger, Dupuytren's contracture, tendinopathies); fractures of the humerus and clavicle; tendinopathy of the distal tendon of the bicepsbrachii muscle. Conclusions. ESWT is a modern and effective method of conservative treatment of orthopedic and traumatological diseases of the upper limb and can be used both independently and in combination with standard methods of conservative treatment.

Application of extracorporeal shock wave therapy in nervous system diseases: A review.

Neurological disorders are one of the leading causes of morbidity and mortality worldwide, and their therapeutic options remain limited. Recent animal and clinical studies have shown the potential of extracorporeal shock wave therapy (ESWT) as an innovative, safe, and cost-effective option to treat neurological disorders. Moreover, the cellular and molecular mechanism of ESWT has been proposed to better understand the regeneration and repairment of neurological disorders by ESWT. In this review, we discuss the principles of ESWT, the animal and clinical studies involving the use of ESWT to treat central and peripheral nervous system diseases, and the proposed cellular and molecular mechanism of ESWT. We also discuss the challenges encountered when applying ESWT to the human brain and spinal cord and the new potential applications of ESWT in treating neurological disorders.

The Effectiveness of Extracorporeal Shockwave Therapy for Midportion Achilles Tendinopathy: A Systematic Review.

Achilles tendinopathy is one of the most common lower limb injuries in both athletes and the general population. Despite the plethora of conservative treatment options available for the management of Achilles tendinopathy, as many as one in four patients will go on to require surgery. Extracorporeal shockwave therapy (ESWT) has emerged as a promising treatment option and has been successful in the management of other common musculoskeletal injuries such as plantar fasciitis. However, the evidence for ESWT in the management of Achilles tendinopathy remains inconclusive. Therefore, the aim of this systematic review was to evaluate the current evidence for the use of ESWT in the management of midportion Achilles tendinopathy.A comprehensive literature search was conducted using the databases MEDLINE (Pubmed), AMED, EMBASE, CINAHL, and CENTRAL. The databases were searched from their inception to December 2021. This was conducted to identify randomised control trials (RCTs) evaluating the effectiveness of ESWT versus control treatment in the management of midportion Achilles tendinopathy.Following a comprehensive search of the literature, a total of 283 articles were identified. Following the screening of titles and abstracts, 236 articles were excluded. The main reasons for exclusion were the identification of duplicates, non-randomised studies, and the use of ESWT on other pathology. Following the exclusion of 236 articles, 47 articles were retrieved for full-text review. Of these 47 articles, 40 were excluded leaving a total of 7 RCTs eligible for inclusion in this review. There was consistent evidence from 4 RCTs that ESWT is effective in the management of midportion Achilles tendinopathy.This review suggests that ESWT is a safe and effective modality for treating midportion Achilles tendinopathy as it reduces pain and improves function. The best available evidence suggests that a combination of ESWT with eccentric exercises and stretching may be even more effective than ESWT alone. Further research is required to confirm this and to determine the optimum ESWT treatment protocol.

Extracorporeal shock wave therapy for the treatment of osteonecrosis and bone vascular diseases: a systematic review of randomized controlled trials.

The aim of the study is to review the available literature on the use of Extracorporeal Shock Wave Therapy (ESWT) for the treatment of osteonecrosis (ON) and bone vascular disease (BVD), to understand its therapeutic potential and compare it with other therapies. A systematic review was performed on the PubMed, Scopus, Science Direct, and Research Gate databases with the following inclusion criteria: 1) randomized controlled trials (RCTs); 2) written in English; 3) published in indexed journals within the last 25 years (1995-2020); and 4) dealing with the use of ESWT for the treatment of BVD or ON. The risk of bias was assessed by the Cochrane Risk of Bias tool for RCTs. Five studies involving 199 patients in total (68 female and 131 male) were included. Patients in the control groups received different treatments, like surgery, bisphosphonates in combination with prostacyclin or ESWT, and hyperbaric oxygen therapy. Looking at the quality of the available literature, none of the studies included could be considered a "good quality" study; only one was ranked as "fair" and the remaining were marked "poor" quality studies. No major complications or serious adverse events were reported in any of the included studies. Based on the available data, ESWT can produce rapid pain relief and functional improvement. Overall, a substandard quality of method emerged from the analysis of the literature, with most studies flawed by relevant bias. Ultimately, ESWT has the potential to be a useful conservative treatment in bone degeneration due to vascular and tissue turnover impairment.

Effectiveness and safety of extracorporeal shock wave treatment for low back pain：a systematic review and meta-analysis of RCTs

This meta-analysis was designed to assess the effectiveness and safety of extracorporeal shock wave therapy (ESWT) for patients with low back pain (LBP). Pubmed, Embase, Cochrane's library, PEDro (Physiotherapy Evidence Database), China National Knowledge Infrastructure (CNKI), and Wanfang Data were searched until December 2019 to identify studies assessing the effectiveness and safety of EPSW for LBP. The prime outcome is pain intensity measured by Visual Analog Scale (VAS) or numeric rating scale (NRS). Other outcomes included functional status, quality of life, psychological outcomes measured by Oswestry Disability Index (ODI), as well as the adverse events. Mean differences (MD) were calculated for continuous outcomes, while odd ratios (OR) were calculated for binary outcomes. Revman 5.3 software was used for statistical analysis. Five randomized controlled trials (RCTs) were finally included in this meta-analysis. The pooled mean difference in post-treatment pain scores was −2.37 (P ＜0.0001), indicating that post-treatment pain scores was significantly higher by 2.37 in control group than in ESWT group. At a mean follow-up time of 4–6 weeks, the pooled mean difference in ODI scores was −14.10 (P ＜0.00001), indicating that the pooled mean difference of post-treatment ODI scores was 14.10 higher in control group than in ESWT group. The use of ESWT is effective in alleviating pain and improving the general functional state for patients with LBP. However, more evidence was needed to verify its safety.

Effectiveness of extracorporeal shockwave therapy for frozen shoulder in perimenopausal diabetic women

Abstract Study aim: To evaluate the effectiveness of extracorporeal shockwave therapy (ESWT) for frozen shoulder in perimenopausal diabetic women. Materials and methods: A single blind randomized controlled trial was conducted on sixty-two perimenopausal women diagnosed with diabetic frozen shoulder. They were divided randomly into two groups. Group (A) received physiotherapy program in the form of maitland joint mobilization for shoulder joint, self-stretching exercises, range of motion exercises (ROM) and strengthening exercises. Sessions were held 3 times per week, for 4 weeks. Group (B) study group: received the same physiotherapy program in addition to ESWT, once per week, for 4 weeks. Visual analogue scale was used to measure pain intensity, shoulder pain and disability index (SPADI) was used to evaluate disability level, while an electrogoniometer was used to measure shoulder flexion, abduction and external rotation range of motion. All measurements were recorded pretreatment and posttreatment program. Results: For intragroup comparison, significant improvement in all treatment outcomes was noted in both groups (P &lt; 0.05). However, no significant differences were found between both groups regarding all outcome measures in case of intergroup comparison in the study (P &gt; 0.05). Conclusion: The use of ESWT have a positive effect in reducing pain and improving shoulder range of motion in perimenopausal women suffering from frozen.

Extracorporeal Shock Wave Therapy Combined with Complex Decongestive Therapy in Patients with Breast Cancer-Related Lymphedema: A Systemic Review and Meta-Analysis.

Breast cancer-related lymphedema (BCRL) is one of the most significant complications seen after surgery. Several studies demonstrated that extracorporeal shock wave therapy (ESWT), in addition to conventional complex decongestive therapy (CDT), had a positive effect on BCRL in various aspects. The systematic review and meta-analysis aim to explore the effectiveness of ESWT with or without CDT on BRCL patients. We searched PubMed, Embase, PEDro, Cochrane Library Databases, and Google Scholar for eligible articles and used PRISMA2020 for paper selection. Included studies were assessed by the PEDro score, Modified Jadad scale, STROBE assessment, and GRADE framework for the risk of bias evaluation. The primary outcomes were the volume of lymphedema and arm circumference. Secondary outcome measures were skin thickness, shoulder joint range of motion (ROM), and an impact on quality-of-life questionnaire. Studies were meta-analyzed with the mean difference (MD). Eight studies were included in the systemic review and four in the meta-analysis. In summary, we found that adjunctive ESWT may significantly improve the volume of lymphedema (MD = −76.44; 95% CI: −93.21, −59.68; p < 0.00001), skin thickness (MD = −1.65; 95% CI: −3.27, −0.02; p = 0.05), and shoulder ROM (MD = 7.03; 95% CI: 4.42, 9.64; p < 0.00001). The evidence level was very low upon GRADE appraisal. ESWT combined with CDT could significantly improve the volume of lymphedema, skin thickness, and shoulder ROM in patients with BCRL. There is not enough evidence to support the use of ESWT as a replacement for CDT. This study was registered with PROSPERO: CRD42021277110.