Three Sessions of Radial Extracorporeal Shockwave Therapy Gives No Additional Benefit Over "Minimal-Dose" Radial Extracorporeal Shockwave Therapy for Patients With Chronic Greater Trochanteric Pain Syndrome: A Double-Blinded, Randomized, Controlled Trial.

OBJECTIVE: To investigate the outcomes following 3 weekly sessions of radial extracorporeal shockwave therapy (rESWT) in patients with chronic greater trochanteric pain syndrome (GTPS) presenting to an NHS Sports Medicine Clinic in the United Kingdom. DESIGN: Double-blinded randomized controlled trial. SETTING: A single NHS Sports Medicine Clinic, in the United Kingdom. PATIENTS: One hundred twenty patients in an NHS Sports Medicine clinic presenting with symptoms of GTPS who had failed to improve with a minimum of 3 months of rehabilitation were enrolled in the study and randomized equally to the intervention and treatment groups. Mean age was 60.6 ± 11.5 years; 82% were female, and the mean duration of symptoms was 45.4 ± 33.4 months (range, 6 months to 30 years). INTERVENTIONS: Participants were randomized to receive either 3 sessions of ESWT at either the "recommended"/"maximally comfortably tolerated" dose or at "minimal dose." All patients received a structured home exercise program involving flexibility, strength, and balance exercises. MAIN OUTCOME MEASURES: Follow-up was at 6 weeks, 3 months, and 6 months. Outcome measures included local hip pain, validated hip PROMs (Oxford hip score, non-arthritic hip score, Victorian Institute of Sport assessment questionnaire), and wider measures of function including sleep (Pittsburgh sleep quality index) and mood (hospital anxiety and depression scale). RESULTS: Results were available for 98% of patients at the 6-month period. There were statistically significant within-group improvements in pain, local function, and sleep seen in both groups. However, fewer benefits were seen in other outcome measures, including activity or mood. CONCLUSION: There were no time × group interaction effects seen between the groups at any time point, indicating that in the 3 sessions, the "recommended-dose" rESWT had no measurable benefit compared with "minimal dose" rESWT in this group of patients with GTPS. The underlying reason remains unclear; it may be that rESWT is ineffective in the treatment of patients with chronic GTPS, that "minimal dose" rESWT is sufficient for a therapeutic effect, or that a greater number of treatment sessions are required for maximal benefit. These issues need to be considered in further research.

Radial Extracorporeal Shockwave Therapy (rESWT) is not superior to "minimal-dose" rESWT for patients with chronic plantar fasciopathy; a double-blinded randomised controlled trial.

BACKGROUND: Investigating outcomes following radial-extra-corporeal-shockwave-therapy (rESWT) in patients with chronic plantar fasciopathy METHODS: This double-blinded RCT in a single NHS Sports medicine clinic recruited 117 patients with chronic plantar fasciopathy randomised equally to either 3 sessions of rESWT or "minimal-dose" respectively. Mean age 51.7 ± 9.6 years, 66 % female, symptom duration: 32.6 ± 30.8 months. RESULTS: "Average pain" improved by 50 % at 6-months, (>1/3 at interim time-points). Statistically significant within-group improvements were identified in pain, local function, and "ability" PROMs in both groups. Fewer benefits in activity levels or mood. No between-group differences were seen at the interim or final time-points. CONCLUSION: 3 sessions of "recommended-dose" rESWT is non-superior to "minimal-dose" rESWT in patients with chronic plantar fasciopathy. rESWT may be ineffective in the treatment of patients with chronic plantar fasciopathy, "minimal-dose" rESWT may be sufficient for a therapeutic effect, or a greater number of treatment sessions may be required for benefit. LEVEL OF EVIDENCE: Level I - Randomised controlled trial.

Post-operative rehabilitation in ankle and hindfoot/midfoot fusion and reconstruction surgery - A scoping survey of UK foot and ankle surgeons and allied health professionals.

OBJECTIVE: There has recently been a paradigm shift in the management of Achilles tendon rupture and ankle fracture rehabilitation with emphasis on early mobilisation. There is, however, no consensus on post-operative rehabilitation for hind/mid-foot fusion and reconstructive surgery.The aim was to scope the post-operative rehabilitation practices of UK foot and ankle surgeons and allied health professionals (AHPs). METHODS: A 10 question online survey was sent to UK surgeons and AHPs via specialist interest groups in February 2019. Quantitative and qualitative data were analysed. RESULTS: 117 surgeons and 55 AHPs responded. There was good agreement between survey responses in the 2 groups. Fifty percent reported that they followed a local post-operative rehabilitation protocol. More than half of respondents (57%) reported that not all patients were referred for post-operative rehabilitation. There was a wide variation in the time point at which patients were instructed to weight bear (2 weeks to >12-weeks). Non-union was a concern of early mobilisation as highlighted by 62% of respondents. Qualitative themes identified were: treatment tailored to individual patients, lack of knowledge about the patient journey, treatment tailored to surgeon preferences, lack of a pathway, variation in practice. CONCLUSIONS: There is a wide variation in the post-op rehabilitation of patients undergoing this surgery in the UK, with a lack of published research in this area. Early rehabilitation could improve patient outcomes, yet the risk of non-union is a major concern. Further research in the form of a multicentre trial is warranted to answer this research question.