Improving methodology when analyzing shockwave evidence

Ramón, Silvia; Leal, Carlos; Schaden, Wolfgang; Moya, Daniel; Guiloff, Leonardo; Freitag, Karin

doi:10.1016/j.spinee.2015.01.008

Cited by 2 publications

(1 citation statement)

References 15 publications

(23 reference statements)

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“…Moreover, the GRADE scale was not used for evaluating the estimated effects; the study was not registered or published, and the time points for post-treatment evaluation were not set. In addition, obvious errors were found in the manuscript; a protocol for systematic review and meta-analysis of ESWT on low back pain was published by Wei et al, but no BioMed Research International subsequent work by the team was found [37]; a systematic review by Seco et al investigated the effectiveness of shockwave therapy for low back pain, but they only included one trial of Fairmed device, which was actually not a shockwave device, as noted by Ramon et al [18,38]; the most recent systematic review of ESWT on CLBP by Walewicz included six trials; however, the finally included studies were in contradiction with the eligibility criteria of the study, and the data were not pooled for estimation [39]. 4.3.…”

Section: Comparison With Other Studiesmentioning

confidence: 99%

Extracorporeal Shockwave Therapy for Treating Chronic Low Back Pain: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Yue

Sun

Chen

et al. 2021

BioMed Research International

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Objective. To assess the effectiveness and safety of extracorporeal shockwave therapy (ESWT) for the treatment of chronic low back pain (CLBP). Methods. This was a systematic review and meta-analysis of randomized controlled trials (RCTs) designed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analysis statement standard. We identified relevant studies by searching multiple electronic databases, trial registries, and websites up to April 30, 2021, and examining reference lists. We selected RCTs that compared ESWT, in unimodal or multimodal therapeutic approaches, with sham ESWT or other active therapies. Two investigators independently extracted data and assessed the risk of bias and quality of the evidence. The main outcomes were pain intensity and disability status, examined as standardized mean differences (SMD) with 95% confidence intervals (CI). The risk of bias was assessed by using Cochrane Back and Neck (CBN) Group risk of bias tool and Jadad score, and GRADE was applied to determine the confidence in effect estimates. Heterogeneity was explored using sensitivity analysis and meta-regression. Results. Ten RCTs, including a total of 455 young to middle-aged individuals (29.2–55.8 years), were identified. Compared with control, the ESWT group showed lower pain intensity at month 1 ( SMD = − 0.81 , 95% CI −1.21 to −0.42), as well as lower disability score at month 1 ( SMD = − 1.45 , 95% CI −2.68 to −0.22) and at month 3 ( SMD = − 0.69 , 95% CI −1.08 to −0.31). No serious shockwave-related adverse events were reported. Conclusion. The use of ESWT in CLBP patients results in significant and quantifiable reductions in pain and disability in the short term. However, further well-conducted RCTs are necessary for building high-quality evidence and promoting the application of ESWT in clinical practice.

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