Effectiveness of extracorporeal shockwave therapy for chronic Achilles tendinopathy: A randomized clinical trial

Vahdatpour, Babak; Forouzan, Hadi; Momeni, Fatemeh; Ahmadi, Mehdi; Taheri, Parisa

doi:10.4103/jrms.jrms_413_16

Cited by 19 publications

(18 citation statements)

References 19 publications

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“…In measures where higher scores indicate more favorable outcomes, ESWT was associated with higher VISA-A score than comparison treatment (MD, 1.53; 95% CI, 0.69 to 2.37; P = .0003; I 2 = 92%) ( Figure 6 ) 10 – 12 , 16 and with higher AOFAS score (MD, 1.35; 95% CI, 0.28 to 2.41; P = .01; I 2 = 93%) ( Figure 7 ). 9 , 15 , 16 The 2 groups did not differ significantly in tenderness score (MD, –0.25; 95% CI, –0.77 to 0.27; P = .34; I 2 = 61%) ( Figure 8 ) 11 , 13 or pain threshold (MD, 0.45; 95% CI, –0.30 to 1.20; P = .24; I 2 = 81%) ( Figure 9 ). 10 , 12 …”

Section: Resultsmentioning

confidence: 94%

“…In measures where lower scores indicate more favorable outcomes (VAS pain, Roles and Maudsley, NRS, and Likert scores), ESWT was associated with lower VAS scores than comparison treatment (MD, –2.14; 95% CI, –2.73 to –1.56; P < .001; I 2 = 88%) ( Figure 2 ) 10 , 12 , 15 , 16 as well as with lower Roles and Maudsley score (MD, –2.80; 95% CI, –3.30 to –2.30; P < .001; I 2 = 69%) ( Figure 3 ) based only on 2 studies. 5 , 6 ESWT was also associated with lower NRS score (MD, –0.58; 95% CI, –1.07 to –0.08; P = .02; I 2 = 69%) ( Figure 4 ) 10 – 12 and lower Likert scale score (MD, −0.46; 95% CI –0.87 to –0.05; P = .03; I 2 = 55%) ( Figure 5 ).…”

Section: Resultsmentioning

confidence: 99%

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Efficacy of Extracorporeal Shock Wave Therapy for Achilles Tendinopathy: A Meta-analysis

Fan

Feng

Cao

et al. 2020

Orthopaedic Journal of Sports Medicine

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Background: Achilles tendinopathy is a frequent sports injury, and extracorporeal shock wave therapy (ESWT) has been proposed as a treatment. Purpose: To compare outcomes between ESWT and other nonsurgical intervention (including sham shock wave therapy) in Achilles tendinopathy patients. Study Design: Systematic review; Level of evidence, 2. Methods: We included 5 randomized controlled trials and 3 case-control studies published between 2005 and 2018. We analyzed pain scores and other outcomes that were reported in more than 3 of the 8 studies. Results: ESWT was associated with significantly better scores than comparison therapy on the visual analog scale for pain ( P < .01), American Orthopaedic Foot & Ankle Society scale ( P = .01), Likert scale for satisfaction ( P = .03), Roles and Maudsley scale ( P < .01), Victorian Institute of Sports Assessment–Achilles questionnaire ( P < .01), and numerical rating scale ( P = .02). The 2 patient groups did not differ significantly in tenderness ( P = .34) or pain threshold ( P = .24). Subgroup analysis showed that ESWT led to better VAS pain scores than comparison treatments at both low-energy level (0.06-0.11 mJ/mm2) and medium-energy level (0.12-0.25 mJ/mm2) and at both shorter (<6 months) and longer (≥6 months) follow-up. Conclusion: ESWT improves pain and functional outcomes in patients with Achilles tendinopathy. Further research is needed to determine the optimal energy level.

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Section: Resultsmentioning

confidence: 94%

Section: Resultsmentioning

confidence: 99%

Efficacy of Extracorporeal Shock Wave Therapy for Achilles Tendinopathy: A Meta-analysis

Fan

Feng

Cao

et al. 2020

Orthopaedic Journal of Sports Medicine

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“…Notranicola et al [ 14 ] recruited patients with symptom duration over 6 months, and 2 months after shock wave therapy, AOFAS raised to only 73 ± 22.9. On the contrary, Vahdatpour et al [ 20 ] observed patients of 4.5 months in disease duration; AOFAS reached as high as 85.85 ± 7.8 at 16 weeks after ESWT. Similarly, Pavone et al [ 29 ] enrolled patients with disease course over 3 months for research, combined with eccentric exercise, AOFAS scores were achieved as 85.2 ± 4.1.…”

Section: Discussionmentioning

confidence: 97%

“…Epidemiologically, in term of gender tendency, some authors believe that CAT influences more male patients than the female [ 12 ], which possibly be related to more frequent physical activities in male exerciser. In fact, a slightly higher incidence of female patients, about 53-59% [ 13 – 19 ], was reported in the majority of literatures, even as high as 77.4% or 81.8% [ 11 , 20 ] was mentioned. In our study, the general rate of female patient is 53.3% (35/66) and slightly higher than male, which is consist with most of articles.…”

Section: Discussionmentioning

confidence: 99%

Extracorporeal Shockwave Therapy for Patients with Chronic Achilles Tendinopathy in Long or Short Course

Yan

Yuan

Zhang

et al. 2020

BioMed Research International

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Object. In this study, our aim is to evaluate the efficiency of extracorporeal shockwave therapy (ESWT) on chronic Achilles tendinopathy (CAT) with different courses of disease. Methods. The data of 66 patients with CAT received ESWT was reviewed. According to the disease courses, those cases were allocated to short-term group (ST group, symptom duration 3-6 months) and long-term group (LT group, symptom duration >6 months). Propensity scores match (PSM) method was conducted to eliminate the confound factors in baseline features including gender, sport history, sides, type of CAT, BMI (body mass index), age, and scores evaluated by AOFAS (American Orthopedic Foot and Ankle Society) and VAS (Visual Analogue Scale) before ESWT. After balancing the features between ST and LT group, postinterventional VAS, AOFAS, and rate of Likert satisfaction scale at the 3rd month after first ESWT was statistically analyzed. Results. Among the baseline features in ST and LT group, gender (female ratio, 44.4% vs 71.4%, p=0.041) and BMI (23.26±2.15 vs 24.63±2.41, p=0.024) were identified as confound factors. After elimination of biased features with PSM, 3 months after first ESWT, AOFAS and VAS in both groups are significantly improved, when compared with their scores at baseline (p<0.01). Moreover, at postintervention month 3 (PIM3), AOFAS in ST group is significantly higher than LT group (85.08±9.83 vs 76.76±9.85, t=76.76±9.85, p=0.019), and the rate of Likert satisfaction in ST group is better than LT group; although, it did not reach but close to significant level (70.6% vs 47.1%, χ2=1.943, p=0.163). However, there is no statistical difference of VAS scores between two groups after ESWT (1.96±0.98 vs 2.24±1.29, t=0.703, p=0.487). Conclusions. ESWT could effectively relieve pain and improve function of hind foot in patients with chronic Achilles tendinopathy, and especially, it could offer better benefit on functional improvement in patients with short duration of CAT symptom.

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“…Current recommended treatment for those with persistent Achilles tendinopathy emphasizes tendon-loading exercises and activity modification/education [1,12] with eventual referral to surgery for severe long-standing cases [13,14]. Placebo-controlled studies of proposed adjunct treatments such as shockwave therapy [15][16][17] or topical glyceryl trinitrate [18,19] have not clearly demonstrated a benefit for Achilles tendinopathy, showing small improvements [16], improvements reported by a single study [19], or no apparent benefit [15,17,18]. There are very few placebo-controlled studies of injection therapies [20][21][22][23][24][25][26] or analgesics (either topical [27] or oral [28]) to inform clinical decision-making.…”

Section: Introductionmentioning

confidence: 99%

Intramuscular stimulation vs sham needling for the treatment of chronic midportion Achilles tendinopathy: A randomized controlled clinical trial

Solomons

Lee

Bruce³

et al. 2020

PLoS ONE

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Background The insertion of filiform needles intramuscularly (a.k.a. intramuscular stimulation/dry needling) has been suggested as a possible treatment for various painful musculoskeletal conditions. Our aim was to answer the question, is intramuscular stimulation more effective than sham intramuscular stimulation/dry needling for the treatment of Achilles tendinopathy? Methods 52 participants with persistent midportion Achilles tendinopathy began and 46 completed one of three treatment protocols which were randomly assigned: (G3) a 12-week rehabilitation program of progressive tendon loading plus intramuscular stimulation (n = 25), (G2) the same rehabilitation program but with sham intramuscular stimulation (n = 19), or (G1) a reference group of rehabilitation program alone (as an additional control) (n = 8). The a priori primary outcome measure was change in VISA-A score at 12 weeks-VISA-A was also measured at 6 weeks, and at 6 and 12 months. Secondary outcome measures include the proportion of patients who rated themselves as much or very much improved (%), dorsiflexion range of motion (degrees), and tendon thickness (mm). Results The study retention was 94% at 12 weeks and 88% at 1 year. VISA-A score improved in all three groups over time (p<0.0001), with no significant difference among the three groups in VISA-A score at the start of the study (mean ± SD: G3 59 ± 13, G2 57 ± 17, G1 56 ± 22), at 12 weeks (G3 76 ± 14, G2 76 ± 15, G1 82 ± 11) or at any other timepoint. The percentage of patients who rated themselves as much or very much improved (i.e. treatment success) was not different after 12 weeks (G3 70%, G2 89%, G1 86% p = 0.94), or at 26 (p = 0.62) or

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Effectiveness of extracorporeal shockwave therapy for chronic Achilles tendinopathy: A randomized clinical trial

Cited by 19 publications

References 19 publications

Efficacy of Extracorporeal Shock Wave Therapy for Achilles Tendinopathy: A Meta-analysis

Efficacy of Extracorporeal Shock Wave Therapy for Achilles Tendinopathy: A Meta-analysis

Extracorporeal Shockwave Therapy for Patients with Chronic Achilles Tendinopathy in Long or Short Course

Intramuscular stimulation vs sham needling for the treatment of chronic midportion Achilles tendinopathy: A randomized controlled clinical trial

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