ABSTRACT
OBJECTIVE: To investigate extracorporeal shock wave therapy effect on knee osteoarthritis compared to a sham or kinesiotherapy by a systematic review and meta-analysis of randomized clinical trials. DATA SOURCES: The search was performed in: Cochrane Library, PubMed, PEDro, Web of Science, EMBASE, Scopus, LILACS, and Scielo. REVIEW METHODS: We performed the online search until October, 2022. The following terms were used (Osteoarthritis) AND ("knee joint") AND ("Extracorporeal Shockwave Therapy"). Eligibility criteria: (1) randomized clinical trials; (2) effects comparison of shockwave therapy to a sham or kinesiotherapy in individuals with knee osteoarthritis; (3) pain and physical function as outcome variables. Risk of bias assessed using the PEDro scale. PROSPERO registration (CRD42021235597). RESULTS: We identified 4217 studies, and 12 were included in the qualitative synthesis and the meta-analysis, totaling 403 individuals submitted to the intervention and 331 control individuals. Compared to sham, shockwave was favored in short-term for the function outcome (SMD = -1.93; 95%CI: [-2.77; -1.09]; I² = 83%; P < 0.01). For the pain outcome, the shockwave was favored in the short (MD = -2.05; 95%CI: [-2.59; -1.51]; I² = 84%; P < 0.01), medium (MD = -3.46; 95%CI: [-4.03; -2.89]; I² = 0%; P < 0.01) and long-term (MD = -2.01; 95%CI: [-3.36; -0.65]; I² = 98%; P < 0.01). The association with kinesiotherapy was favored in the short term for the function outcome (SMD = -1.88; 95%CI: [-2.98; -0.78]; I² = 94%; P < 0.01) and favored for the pain outcome in the short (MD = -1.44; 95%CI: [-1.81; -1.07]; I² = 37%; P = 0.14), medium (MD = -1,31; 95%CI: [-1.76; -0,85]; I² = 0%; P = 0.41), and long terms (MD = -1.63; 95%CI: [-1.73; -1.52]; I² = 0%; P = 0.43). CONCLUSION: Shockwave therapy may improve functionality in patients with knee osteoarthritis in the short term and pain in all follow-up moments, compared with sham. When associated to kinesiotherapy, it may improve function in the short term and pain in all follow-up time points, although improvement in pain may not be clinically significant.
Subject(s)
Extracorporeal Shockwave Therapy , Osteoarthritis, Knee , Humans , Osteoarthritis, Knee/drug therapy , Extracorporeal Shockwave Therapy/adverse effects , Knee Joint , Pain/etiologyABSTRACT
BACKGROUND: Myofascial Pain Syndrome causes disability in daily life activities and despite all efforts, it continues to be a challenge, perpetuating suffering, overloading services and costs. New treatment options need to be tested. OBJECTIVE: We aimed to quantify the rESWT short-term analgesic effect and identify the predictors of success through comparing results achieved in MPS and Articular Pain (AP). METHOD: Retrospective cohort study of 1,580 patients with Myofascial Pain Syndrome or Articular Pain underwent two weekly radial Extracorporeal Shock-wave Therapy sessions. The pain intensity was measured by Visual Analog Scale before and one week after the end of the treatment (3 weeks). RESULTS: The therapy decreases pain by 62.50% (p< 0.0001), with a high success rate (91.59%) and a low worsening of baseline conditions rate (2.1%). The best recommendation is for patients with intense myofascial pain (Visual Analog Scale ⩾ 70 mm), using high shock-wave frequency (⩾ 15 Hz). CONCLUSIONS: Two rESWT sessions promote pain relief, with a high success rate and low rates of treatment abandonment and worsening. The best results are obtained in myofascial pain patients with high pain intensity, treated with high-frequency dosage.
Subject(s)
Extracorporeal Shockwave Therapy/methods , Myofascial Pain Syndromes/therapy , Adult , Aged , Female , Humans , Male , Middle Aged , Pain Management/methods , Pain Measurement , Prognosis , Retrospective Studies , Treatment OutcomeABSTRACT
RESUMEN Introducción: La terapia con ondas de choque extracorpórea de baja intensidad ha demostrado ser útil en el tratamiento de los pacientes con angina de pecho refractaria. Objetivo: Valorar los resultados de este tipo de terapia en pacientes con angina refractaria al tratamiento farmacológico. Método: Se realizó un estudio cuasiexperimental en 30 pacientes con angina de pecho refractaria a tratamiento, seleccionados de forma no probabilística a partir de los criterios de inclusión. A todos los pacientes se les aplicó terapia con ondas de choque extracorpórea de baja intensidad en el Cardiocentro Ernesto Guevara de Santa Clara, en el período comprendido de enero a diciembre de 2017. Se analizaron variables epidemiológicas, clínicas y ecocardiográficas al inicio del tratamiento y 6 meses después de concluido este. Resultados: Los resultados obtenidos demostraron una mejoría de la clase funcional (CF) de la Canadian Cardiovascular Society (CCS). Previo al tratamiento el 76,7% de los pacientes tenían una CF III y un 23,3% una CF IV, y a los 6 meses de concluida la terapia el 73,3% mejoró a la CF II y solo un 26,7% quedó en CF III. También se evidenció mejoría con respecto a parámetros ecocardiográficos como la motilidad regional y la fracción de eyección del ventrículo izquierdo, la cual, en los hombres, de una media al inicio de la terapia de un 37,81% alcanzó 44,14% a los 6 meses de concluida; y en las mujeres, de una media de 37,11% inicial llegó a 47,22% a los 6 meses después. Conclusiones: El tratamiento con ondas de choque constituye una alterativa terapéutica para los pacientes con angina refractaria.
ABSTRACT Introduction: Low intensity extracorporeal shock wave therapy has proven useful in the treatment of patients with refractory angina pectoris. Objective: To assess the results of this type of therapy in patients with refractory angina to drug treatment. Method: A quasi-experimental study was carried out in 30 patients with refractory angina pectoris to treatment, selected in a non-probabilistic way, taking into account the following inclusion criteria. All patients were applied low intensity extracorporeal shock wave therapy in the Cardiocentro Ernesto Guevara of Santa Clara, in the period from January to December 2017. Epidemiological, clinical and echocardiographic variables were analyzed at the beginning of the treatment and six months after it was completed. Results: The results obtained demonstrated an improvement of the functional class (FC) of the Canadian Cardiovascular Society (CCS). Previous to treatment, 76.7% of patients had a FC III and 23.3% a FC IV, and after six months of completed therapy, 73.3% improved to FC II and only 26.7 % remained in FC III. There was also an improvement with respect to echocardiographic parameters such as regional motility and left ventricular ejection fraction, which, in men, of an average at the start of therapy of 37.81% it reached 44.14% at six months of completed; and in women, of an average of 37.11% initially, it reached 47.22 % six months later. Conclusions: The treatment with shock waves represents a therapeutic alternative for patients with refractory angina.
Subject(s)
Angina Pectoris , Extracorporeal Shockwave Therapy , Neovascularization, PathologicABSTRACT
BACKGROUND: Acute injuries of the hamstring muscle complex (HMC) type 3b (interfascicle/bundle-tear) are frequently observed in various sports disciplines both in elite and recreational sport. The treatment of choice of acute HMC injuries type 3b is a progressive physiotherapeutic exercise programme. Besides this, there is currently only insufficient scientific evidence to support other treatment methods, including local infiltrations and injections of platelet-rich-plasma. Very recently, it was demonstrated that extracorporeal shock wave therapy (ESWT) may accelerate regeneration after acute skeletal muscle injury. The aim of the present study is to test the hypothesis that the combination of radial ESWT (rESWT) and a specific rehabilitation program (RP) is effective and safe in treatment of acute HMC injury type 3b in athletes, and is statistically significantly more effective than the combination of sham-rESWT and RP. METHODS: We will perform a double blind, randomized, sham-controlled clinical trial at the clinic KinEf Kinesiología Deportiva, Ciudad Autónoma de Buenos Aires, Argentina. Forty patients with acute HMC injury type 3b will be randomly allocated to receive either rESWT (nine rESWT sessions; three sessions per week; 2500 radial extracorporeal shock waves (rESWs) per session; energy density depending on what the patient tolerates) or sham-rESWT. In addition, all patients will receive a specific rehabilitation program that will last for 8 weeks. The primary outcome measure will be the individual time (days) necessary to return to play. Secondary outcomes will include the presence or absence of reinjury during a time period of 6 months after inclusion into the study. DISCUSSION: Because of the lack of adequate treatment options for acute HMC injury type 3b in athletes and particularly the high reinjury rate, we hypothesize that the results of this trial will be of importance and have impact on clinical practice. TRIAL REGISTRATION: ClinicalTrials.gov ID NCT03473899 . Registered March 22, 2018.
Subject(s)
Athletes , Athletic Injuries/diagnosis , Athletic Injuries/rehabilitation , Extracorporeal Shockwave Therapy/methods , Hamstring Muscles/injuries , Adolescent , Adult , Athletic Injuries/therapy , Combined Modality Therapy/methods , Double-Blind Method , Female , Follow-Up Studies , Humans , Male , Placebos , Prospective Studies , Soft Tissue Injuries/rehabilitation , Soft Tissue Injuries/therapy , Treatment Outcome , Young AdultABSTRACT
Extracorporeal shock wave therapy (ESWT) has been extensively studied for its multiple biological properties, and although it is widely applied in esthetical procedures, little is known about its effects on the epidermis and dermis. In this study, a histological and immunohistochemical study of the effects of ESWT was performed on rat skin. Forty-five female rats were treated with one or two sessions of ESWT and sacrificed on days 1, 7, 14, and 21 after treatment. The samples were histologically processed and then morphometric analyses were performed to assess the epidermis, dermis, and subcutaneous fat tissue thickness. Immunohistochemical reactions were also performed against the antibodies: basic fibroblastic growth factor (FGF2), its receptor (FGFR1), and α-smooth muscle actin. Slides were scanned and digitally assessed, to determine the microvessel density (MVD) and digital scoring of the immunohistochemical staining. The results showed that ESWT produced a significantly higher collagen content, MVD, and epidermis and dermis thickness than the control, non-treated group. Both in epidermis and dermis, FGF2 was overexpressed in the ESWT-treated groups, whereas FGFR1 was increased only in the group treated with two ESWT sessions at 21-days post-treatment. The ESWT-treated groups have also shown diminished thickness of subcutaneous fat tissue. In conclusion, ESWT induces neocollagenesis and neoangiogenesis, and upregulates the FGF2 expression, particularly in the groups treated with two sessions. Furthermore, it was demonstrated that overexpression of FGF2 on skins treated with ESWT seems to be a key role on its mechanism of action.
Subject(s)
Extracorporeal Shockwave Therapy , Skin/pathology , Animals , Cell Proliferation/radiation effects , Collagen/metabolism , Epidermis/pathology , Epidermis/radiation effects , Female , Fibroblast Growth Factors/metabolism , Hyperplasia , Microvessels/metabolism , Microvessels/pathology , Neovascularization, Physiologic , Rats , Receptors, Fibroblast Growth Factor/metabolismABSTRACT
Introducción La fascitis plantar crónica (FPC) es una afección dolorosa, en la cual el objetivo principal del tratamiento es aliviar el dolor y restaurar la función. La terapia de ondas de choque (TOCH) ha demostrado eficacia en el tratamiento de la fascitis plantar con pocos efectos secundarios en comparación con otros métodos conservadores. El objetivo del estudio es comparar la respuesta al tratamiento de TOCH frente a la infiltración con corticosteroides en el tratamiento de la fascitis plantar crónica. Materiales y métodos Sesenta pacientes con FPC fueron distribuidos de forma aleatoria para recibir TOCH (grupo A, n=36) o infiltración con corticosteroides (grupo B, n=24) a través de un programa de generación aleatorizada. Fueron evaluados con EVA y AOFAS para el retropié antes del tratamiento, inmediatamente después del tratamiento, a los 3, 6 y 12 meses posteriores al tratamiento. Resultados Los dos grupos fueron similares en características demográficas. Ambos grupos mejoraron durante el tratamiento y el período de seguimiento. La media de EVA disminuyó de 8 a 1,68 (p <0,001) en el grupo A y de 6,75 a 1,31 (p <0,001) en el grupo B. En el AOFAS presentó un incremento medio de 50,3 a 67,8 (p <0,001) en el grupo A y de 51,3 a 66 (p <0,001) en el grupo B a los 12 meses de seguimiento. A los 3 meses, el grupo B presentó una puntuación media de EVA más baja que en el grupo A (1,12 frente a 1,96; p=0,035), pero al final del seguimiento se observó mejoría en ambos grupos. Discusión Las infiltraciones con corticosteroideas y TOCH son efectivas en la reducción de síntomas y el incremento de la funcionalidad de los pacientes diagnosticados de FPC. Nivel de evidencia clínica Nivel II.
Background Chronic plantar fasciitis (CPF) is a painful condition where the primary goal of treatment is relieve the pain and restore function. Extracorporeal shockwaves therapy (ESWT) has shown efficacy in the treatment of plantar fasciitis with reported few side effects compared to other conservative methods. The purpose of the study is to compare the response to treatment of ESWT against corticosteroid infiltration for PF using VAS (Visual Analogue Scale) and AOFAS (American Orthopedic Foot and Ankle Society's) hind foot scales. Materials & methods Sixty patients with PF were randomized to receive ESWT (group A, n=36) or corticosteroid infiltration (group B, n=24) through a program of random number generation. They were evaluated with VAS and AOFAS hind foot scales before treatment, immediately after treatment and at 3, 6 and 12 months post treatment. Results The two groups were similar in demographic characteristics. Both groups improved during treatment and follow-up period. The mean VAS decreased from 8 to 1.68 (p <0.001) in group A and 6.75 to 1.31 (p <0.001) in group B and presented a mean increase in AOFAS scale from 50.3 to 67.8 (p <0.001) in group A and 51.3 to 66 (p <0.001) in group B at 12 months follow up. At 3 months, the B group presented a lower average score in VAS when compared with patients in group A (1.12 vs 1.96; p=0.035). Finally, follow-up improvement was seen in both groups with no significant differences. Discussion ESWT and corticosteroid injections are both effective in reducing symptoms and increased functionality when applied to patients diagnosed with CPF. Evidence level II.
Subject(s)
Humans , Extracorporeal Shockwave Therapy , Adrenal Cortex Hormones , Fasciitis, Plantar , Anesthesia, LocalABSTRACT
BACKGROUND: A substantial body of evidence supports the use of focused extracorporeal shock wave therapy (fESWT) in the non-invasive treatment of fracture nonunions. On the other hand, virtually no studies exist on the use of radial extracorporeal shock wave therapy (rESWT) for this indication. METHODS: We retrospectively analyzed 22 patients treated with rESWT for fracture nonunions of superficial bones that failed to heal despite initial surgical fixation in most cases. Radial extracorporeal shock wave therapy was applied without anesthesia in three rESWT sessions on average, with one rESWT session per week and 3000 radial extracorporeal shock waves at an energy flux density of 0.18 mJ/mm2 per session. Treatment success was monitored with radiographs and clinical examinations. RESULTS: Six months after rESWT radiographic union was confirmed in 16 out of 22 patients (73%), which is similar to the success rate achieved in comparable studies using fESWT. There were no side effects. The tibia was the most common treatment site (10/22) and 70% of tibia nonunions healed within 6 months after rESWT. Overall, successfully treated patients showed a mean time interval of 8.8 ± 0.8 (mean ± standard error of the mean) months between initial fracture and commencement of rESWT whereas in unsuccessfully treated patients the mean interval was 26.0 ± 10.1 months (p < 0.05). In unsuccessful tibia cases, the mean interval was 43.3 ± 13.9 months. CONCLUSIONS: Radial extracorporeal shock wave therapy appears to be an effective and safe alternative in the management of fracture nonunions of superficial bones if diagnosed early and no fESWT device is available. The promising preliminary results of the present case series should encourage the implementation of randomized controlled trials for the early use of rESWT in fracture nonunions.