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

Abstract

Extracorporeal shockwave therapy (ESWT) has been recommended for managing pain in patients with knee osteoarthritis (KOA). The difference in therapeutic effects between radial shockwave characteristics (RaSW) and focused shockwave characteristics (FoSW) with different energy levels for KOA remains controversial. The purpose of this network meta-analysis (NMA) was to identify the effects relative to the different ESWT regime and combination treatments on pain and functional outcomes in individuals with KOA. The randomized controlled trials (RCTs) which investigated the efficacy of RaSW, FoSW, and combination treatments in patients with KOA were identified by searches of electronic databases. The included RCTs were analyzed through NMA and risk-of-bias assessment. We analyzed 69 RCTs with a total of 21 treatment arms in the NMA. Medium-energy FoSW plus physical therapy, medium-energy acupoint RaSW plus Chinese medicine, and high-energy FoSW alone were the most effective treatments for reducing pain [standard mean difference (SMD) = −4.51], restoring function (SMD = 4.97), and decreasing joint inflammation (SMD = −5.01). Population area and study quality influenced the treatment outcomes, particularly pain. Our findings indicate that medium-energy ESWT combined with physical therapy or Chinese medicine is beneficial for treating pain and increasing function in adults with KOA.

Multiple Injections of Platelet-Rich Plasma Versus Hyaluronic Acid for Knee Osteoarthritis: A Systematic Review and Meta-Analysis of Current Evidence in Randomized Controlled Trials

“…Pain is the main symptom for KOA patients, which severely decreases the quality of life [ 55 ] and the function of joints [ 56 ]. After long-term disease, patients with KOA showed higher pain sensitivities at the knee joints [ 57 ], further lowering treatment sensitivities.…”

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“…The VAS score and WOMAC pain, stiffness, and function indices were significantly improved at 5 and 12 weeks post treatment in the ESWT group compared to placebo [37]. To further analyze ESWT effects on OA based on dosage and delivery type, Liao et al [38] performed a meta-analysis of randomized controlled trials including medium-Copyright © Steven Sampson EPMR.MS.ID.000596. 4(5).2024 energy, high-energy, radial, and focal shockwave therapy.…”

“…4(5).2024 energy, high-energy, radial, and focal shockwave therapy. In their 2022 analysis, Liao reports medium-energy focal shockwave therapy in conjunction with physical therapy as the most beneficial for pain reduction related to knee OA [38]. These studies demonstrate that ESWT can improve pain and function in patients with osteoarthritis, but the optimal dosage and delivery method has yet to be determined [36,39,40].…”

Effectiveness of Rehabilitation for Osteoarthritis of the Knee: A Scoping Review of Network Meta-Analyses

“…The characteristics of the included NMAs are presented in Table 1 . These were published in the following years: 2013 (n=1) [ 25 ], 2014 (n=1) [ 26 ], 2015 (n=1) [ 27 ], 2019 (n=2) [ 19 , 20 ], 2021 (n=1) [ 28 ], and 2022 (n=2) [ 29 , 30 ]. Furthermore, these NMAs were conducted in Australia [ 28 ], China [ 26 , 27 ], Georgia [ 19 ], Norway [ 30 ], Taiwan [ 29 ], and the United Kingdom [ 20 , 25 ].…”

“…Table 2 displays the treatment characteristics and participant outcomes for all eight NMAs. Five NMAs compared exercise therapies [ 19 , 20 , 25 , 28 , 30 ], while three compared various physical agents [ 26 , 27 , 29 ]. Quality of life was measured using SF-12, RAND 36, or SF-36 [ 20 , 28 ].…”