The effects of shockwave therapy on musculoskeletal conditions based on changes in imaging: a systematic review and meta-analysis with meta-regression.

BACKGROUND: Shockwave 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. METHODS: A 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. RESULTS: Sixty-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. CONCLUSIONS: SWT 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.

Perception of tertiary care clients toward the availability of physical therapy service at primary health care centers in Saudi Arabia: a cross-sectional survey.

[Purpose] To explore the views of clients referred for physical therapy in a tertiary care setting regarding the integration of physical therapy service at primary health care centers. [Participants and Methods] A self-administered questionnaire was distributed to eligible Saudi clients. The questionnaire consisted of three sections including demographic information section; closed-ended section with 6 Likert scale items on the perceptions of potential advantages of physical therapy service at the primary health care level; and open-ended section on potential disadvantages and barriers of implementing physical therapy service. The surveys were described and analyzed quantitatively and qualitatively. [Results] A total of 412 participants were included in the analysis (56.8% females). Participants' mean age was 35.7 ± 21.9 years; 67.2% were Riyadh city residents; and 38.1% had musculoskeletal conditions. Seventy-five percent responded in support for the availability of physical therapy service at the primary health care level. Demographic characteristics had no effect on the level of support to the service availability. [Conclusion] The results of this survey demonstrated high positive support for the integration of physical therapy service at primary health care centers in Saudi Arabia. However, challenges and barriers identified by the study results require attention when physical therapy services are to be established.

The perception of physical therapy leaders in Saudi Arabia regarding physical therapy scope of practice in primary health care.

[Purpose] To explore the views of the physical therapy service leaders in Saudi Arabia regarding the integration of physical therapy service in primary health care settings. [Subjects and Methods] A self-administered questionnaire consisting of both open and closed ended questions was distributed during May-July 2013 via email to physical therapy leaders representing different regions and health care providers in Saudi Arabia. [Results] Twenty-six participants answered the questionnaire. Eighty five percent of the sample had ≥ 10 years of experience with 57.6% of them holding a post-graduate degree. Participants were from different health care providers and represented different geographical regions of Saudi Arabia. Eighty one percent of the sample reported that the adoption of physical therapy services in primary health care would be advantageous, as it would offer earlier access to health care and would be more cost-effective. The respondents also stated that such a service would contribute towards the prevention of common non-communicable health diseases. [Conclusion] The results of this survey provide generally positive recommendations for the provision of physical therapy service in Saudi Arabia primary health care centers. However, challenges and barriers identified by this study require consideration during the development of the service.

Evaluation of treatment parameters for focused-extracorporeal shock wave therapy in knee osteoarthritis patients with bone marrow lesions: a pilot study.

OBJECTIVES: To evaluate the effect of different dosage parameters of focused-extracorporeal shock wave therapy on pain and physical function in knee osteoarthritis patients with bone marrow lesions. In addition, to investigate pathophysiological changes based on imaging and biomarker measures. METHODS: Using a single-case experimental design, a total of 12 participants were randomly allocated in 4 equal groups of 3 to receive different dosages of focused-extracorporeal shock wave therapy. Each group received either 4 or 6 sessions of 1500 or 3000 shocks over 4 or 6 weekly sessions. Participants underwent repeated measurements during the baseline, intervention, and post-intervention phases for Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, aggregated locomotor function score and pressure pain threshold. Imaging and inflammatory biomarker outcomes were measured at baseline and 3 months following the intervention. RESULTS: The group receiving the highest dosage of focused-extracorporeal shock wave therapy showed clinical improvements superior to those of participants in the other 3 groups. Statistically significant changes during the follow-up phase in contrast to baseline measurements for the WOMAC score (Tau-U= -0.88, p < 0.001), aggregated locomotor function score (Tau-U= -0.77, p = 0.002), and pressure pain threshold (Tau-U= 0.54, p = 0.03) were observed. Bone marrow lesion and inflammatory cytokines demonstrated no change. CONCLUSION: A dose-dependent effect for focused-extracorporeal shock wave therapy on osteoarthritis-related symptoms was suggested. However, these improvements were not associated with changes in the underlying pathophysiological mechanisms.

The effectiveness of extracorporeal shock wave therapy on chronic achilles tendinopathy: a systematic review.

BACKGROUND: Achilles tendinopathy is a pathological state resulting from repetitive loading or stress on the tendon. Extracorporeal shock wave therapy (ESWT) is hypothesized to be an effective alternative intervention to surgery when other conservative therapies fail. This systematic review investigated the effectiveness of ESWT in the treatment of insertional and noninsertional Achilles tendinopathies. METHODS: Articles were electronically searched from the Cochrane Controlled Trials Register, MEDLINE, CINAHL, EMBASE, and SPORTDiscus using a comprehensive search strategy. Studies were included if they were prospective clinical trials examining the effectiveness of ESWT for insertional or noninsertional Achilles tendinopathies. Methodological quality of included studies was assessed using PEDro scale and Modified McMaster tool. The strength of the evidence was reported using the National Health and Medical Research Council body of evidence framework. A narrative summary of the findings was presented. RESULTS: Four of the included studies were randomized controlled trials, and 2 were pre-post study designs. Common methodological deficiencies included not blinding the clinician and participants. There was consistent evidence from 4 reviewed studies on the effectiveness of ESWT in the management of patients with chronic Achilles tendinopathies at a minimum 3 months' follow-up. CONCLUSION: Overall, our review showed satisfactory evidence for the effectiveness of low-energy ESWT in the treatment of chronic insertional and noninsertional Achilles tendinopathies at a minimum 3 months' follow-up before considering surgery if other conservative management fails. However, combining ESWT with eccentric loading appears to show superior results. LEVEL OF EVIDENCE: Level 1, systematic meta-analysis.

Influence of Work-Related Safety and Health Guidelines on Knowledge and Prevalence of Occupational Back Pain among Rehabilitation Nurses in Saudi Arabia: A 6-Month Follow-Up Study.

BACKGROUND: Nurses are frequently involved in different types of patient handling activities in different departments of the hospitals. Mishandling the patients causes accumulative stress on their spine that results in occupational back pain (OBP), substantial morbidity, and incurred cost. OBJECTIVES: This study aimed to observe the influence of work-related safety and health guidelines on knowledge and prevalence of occupational back pain among rehabilitation nurses in Saudi Arabia. METHODOLOGY: This cohort study was conducted with the inclusion of a total of 116-registered rehabilitation nurses (97-female, 19-male, mean age = 39.6-years) from different regions of Saudi Arabia. After the invitation, these nurses attended an ergonomic workshop focusing on work-related safety and patient handling guidelines, risk assessment, and control of OBP. A self-administered questionnaire was used to assess the knowledge, risk, and prevalence of OBP at baseline and 6-months follow-up. RESULTS: The perceived knowledge score significantly improved (95% CI; t = 4.691; p < 0.001; Cohen's d = 0.72) at 6-month follow-up (mean ± SD = 81.6 ± 18.2) from its baseline score (mean ± SD = 68.2 ± 19.2). Likewise, the prevalence score of OBP markedly reduced from 71.5% (baseline) to 65.0% (6-month follow-up). CONCLUSION: The level of knowledge highly improved and the prevalence of OBP markedly reduced within a span of 6-month among rehabilitation nurses in Saudi Arabia after attending an ergonomic workshop. Importantly, the nurses learned and geared up themselves for practicing the safe patient handling guidelines to avoid occupational back pain in the future. Therefore, rehabilitation nurses should update their knowledge and awareness about occupational safety and health guidelines, risk assessments, and control of OBP at a regular interval for increasing the knowledge and reducing the prevalence of OBP among them.

Occupational back pain among rehabilitation nurses in Saudi Arabia: the influence of knowledge and awareness.

Occupational low back pain among nurses has been the subject of research studies worldwide. However, evidence of the influence of nurses' awareness of safe handling practices and compliance with standard guidelines on low back pain remains scarce. This study examined the association between occupational low back pain and level of awareness of back care, and described the self-reported nature of low back pain in relation to organizational policies among nurses in Saudi Arabia. A total of 155 nurses working in a rehabilitation hospital participated in the study. The lack of a patient handling policy at the workplace was identified as a significant risk factor for the development of low back pain, whereas exercising regularly was a protective factor. Not only mechanical exposure but also organizational factors and level of awareness were related to the development of low back pain. This study highlights the need to develop institutional plans for injury reporting, and provides evidence of the importance of incorporating awareness as part of prevention strategies.