Extracorporeal Shock Wave Therapy for the Treatment of Osteoarthritis: A Systematic Review and Meta-Analysis

Abstract

Background. Osteoarthritis is the most common musculoskeletal disease. Extracorporeal shockwave therapy had shown an effect on osteoarthritis in both some animal experiments and clinical studies, but there was no systematic review to confirm the value of shockwave therapy in the treatment of all types of osteoarthritis and compare it with other traditional therapies (especially traditional Chinese medicine). Method. PubMed, Medline, the Cochrane Central Register of Controlled Trials, Web of Science, Chinese National Knowledge Infrastructure, WANFANG database, and VIP database were searched up to December 10, 2019, to identify randomized controlled trials comparing shockwave therapy and other treatments for osteoarthritis. Visual analogue scale and the Western Ontario and McMaster Universities Osteoarthritis Index were extracted and analyzed by RevMan and STATA software as outcomes of pain reduction and functional improvement. Adverse reactions were recorded to evaluate the safety of shockwave therapy. Results. Shockwave therapy had significant improvement in both pain reduction and functional improvement compared with placebo, corticosteroid, hyaluronic acid, medication, and ultrasound (P < 0:05). In functional improvement, shockwave therapy showed statistical improvement compared with kinesiotherapy and moxibustion (P < 0:05) but not with acupotomy surgery (P = 0:24). A significant difference between shockwave therapy and platelet-rich plasma was observed in pain reduction (P < 0:05) but not in functional improvement (P = 0:89). Meanwhile, a statistical difference was found between shockwave therapy and fumigation in functional improvement (P < 0:05) but not in pain reduction (P = 0:26). Additionally, there was no statistically significant difference between shockwave therapy and manipulation in both pain reduction (P = 0:21) and functional improvement (P = 0:45). No serious adverse reaction occurred in all of studies. Conclusions. Extracorporeal shockwave therapy could be recommended in the treatment of osteoarthritis as a noninvasive therapy with safety and effectiveness, but the grade of recommendations needs to be discussed in a further study.

Osteoarthritis year in review 2020: rehabilitation and outcomes

“…We found evidence to support the use of joint mobilization 66,67 for knee OA, and dry needling 36 in hip OA. In contrast, there was conflicting evidence for the use of laser therapy 26,32 for thumb OA, ECSW therapy 23,24,29,62 and kinesiotape 33,63,64 for hand and knee OA, therapeutic ultrasound 27,59 , and PEMF 25 for knee OA, and neurodynamic mobilizations 34 for hand OA. These findings reinforce existing guidelines 3 that suggest these interventions should only be considered as an adjunct, not standalone, treatments for persons with OA.…”

“…This included one SR of guidelines 14 , one SR of SRs and meta-analyses 16 , and 16 SRs of RCTs (Table II). Interventions investigated included various individual (aquatic 19 , whole body vibration 22 , proprioceptive 21 , yoga 30 , resistance-based 20 ) or combined 14,16,18,28,31 exercisetherapies/physical activities, technologies (wearable activity trackers) 15 and behaviour change approaches 17 to improve adherence to exercise and physical activity (PA), and modalities (Extracorporeal Shockwave Therapy; ESWT 23,24,29 , Pulsed Electromagnetic Field Therapy; PEMF 25 , laser therapy 26 ; and therapeutic ultrasound 27 ).…”

Physical Agent Modalities in Early Osteoarthritis: A Scoping Review

“…Emerging evidence supports ESWT as non-invasive therapy for OA [25], whereas data about the effectiveness of this physical modality for patients with EOA are lacking. Chou et al [13] have shown on animal models that ESWT has protective effects for joint tissues (i.e., articular cartilage, synovium, subchondral bone), delaying the progression of OA.…”

Relative Effect of Extracorporeal Shockwave Therapy Alone or in Combination with Noninjective Treatments on Pain and Physical Function in Knee Osteoarthritis: A Network Meta-Analysis of Randomized Controlled Trials

“…A number of systemic review and meta-analysis studies have investigated the efficacy of ESWT in the treatment of KOA [ 37 , 38 , 39 , 40 , 41 , 42 , 43 ]. Most trials included in these reviews and meta-analysis studies conducted an ESWT intervention in combination with noninjection treatments such as conventional physical therapy (CPT) and traditional Chinese medicine (TCM).…”