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Clin Rehabil. 2019 Sep;33(9):1419-1430. doi: 10.1177/0269215519846942. Epub 2019 May 8.

Clinical efficacy of extracorporeal shockwave therapy for knee osteoarthritis: a systematic review and meta-regression of randomized controlled trials.

Liao CD1,2, Tsauo JY1, Liou TH2,3, Chen HC2,3,4, Huang SW2,3,5.

Author information

1
1 School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei.
2
2 Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei.
3
3 Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei.
4
4 Center for Evidence-Based Health Care, Shuang Ho Hospital, Taipei Medical University, Taipei.
5
5 Graduate Institute of Sports Science, National Taiwan Sport University, Taoyuan.

Abstract

OBJECTIVE:

This study determined the clinical efficacy of extracorporeal shockwave therapy and the predictors of its efficacy for knee osteoarthritis.

DATA SOURCES:

Electronic databases and search engines, namely MEDLINE, PubMed, EMBASE, Cochrane Library Database, Physiotherapy Evidence Database (PEDro), China Academic Journals Full-text Database, and Google Scholar, were searched until 5 March 2019, for randomized controlled trials without restrictions on language and publication year.

REVIEW METHODS:

Eligible trials and extracted data were identified by two independent investigators. The included articles were subjected to a meta-analysis and risk of bias assessment. Outcomes of interest included treatment success rate, pain, and physical function outcomes. A meta-regression analysis was performed to determine the predictors of treatment outcomes following shockwave therapy.

RESULTS:

We included 50 trials (4844 patients) with a median (range) PEDro score of 6 (5-9). Meta-analyses results revealed an overall significant effect favoring shockwave therapy on the treatment success rate (odds ratio 3.22, 95% confidence interval (CI) 2.21-4.69, P < 0.00001; heterogeneity (I2) = 62%), pain reduction (standardized mean difference (SMD) -2.02, 95% CI -2.38 to -1.67, P < 0.00001; I2 = 95%), and Western Ontario and McMaster Universities Osteoarthritis Index function outcome (SMD -2.71, 95% CI -3.50 to -1.92, P < 0.00001; I2 = 97%). Follow-up duration and energy flux density were independent significant predictors of shockwave efficacy.

CONCLUSION:

Shockwave therapy is beneficial for knee osteoarthritis. Shockwave dosage, particularly the energy level and intervention duration, may have different contributions to treatment efficacy.

KEYWORDS:

Extracorporeal shockwave therapy; function outcome; knee osteoarthritis; pain

PMID:
31066293
DOI:
10.1177/0269215519846942
[Indexed for MEDLINE]

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