H. Alabbad1,2
1Curtin University, School of Physiotherapy and Exercise Science, Perth, Australia, 2King Fahad Medical City, Physical Therapy, Riyadh, Saudi Arabia
Background: Shockwave therapy (SWT) is a commonly used intervention for a number of musculoskeletal conditions with varying clinical outcomes. However, the capacity of SWT to influence pathophysiological processes and the morphology of affected tissues remains unclear.
Purpose: The primary aim of this review was to explore the available evidence from clinical prospective trials with regard to any changes in the morphology of musculoskeletal lesions following SWT, as measured by imaging parameters. The secondary aim was to investigate significant predictors for the SWT effects using meta-regression.
Methods: A comprehensive search of Medline, Embase, Cochrane Controlled Trials Register, CINAHL and SportDiscus was conducted from inception to October 2018. Prospective clinical trials evaluating the effectiveness of SWT based on changes in imaging outcomes were eligible for inclusion. Articles were evaluated independently for risk of bias using the Cochrane Risk of Bias list and the Methodological Index for Non-Randomized Studies. Random-effects meta-analysis and meta-regression with a priori determined covariates was conducted for each condition to determine potential predictors of SWT effects.
Results: Sixty-three studies were included, with data from 27 studies available for effect size pooling. Meta-analyses and meta-regression on imaging outcomes were performed for rotator cuff calcific tendinitis (n = 11), plantar fasciitis (n = 7) and osteonecrosis of the femoral head (n = 9). There was an overall reduction in the size of measured lesion following SWT (MD 8.44mm (95%CI 4.30, 12.57), p < 0.001) for calcium deposit diameter, (MD 0.92mm (95%CI 0.03, 1.81), p = 0.04) for plantar fascia thickness and (MD 4.84% (95%CI -0.06, 9.75), p = 0.05) for lesion size in femoral head osteonecrosis. Meta-regression showed no influence of SWT dosage parameters, however, baseline lesion size was an independent predictor for changes in imaging outcomes.
Conclusion(s): SWT altered the morphology of musculoskeletal conditions, potentially reflecting changes in underlying pathophysiological processes. The parameters of SWT dosage are not significant predictors of changes in imaging outcomes. Lack of adequate reporting of imaging outcomes limited the conclusions that could be drawn from the current review.
Implications: Current available research has provided preliminary evidence related to the capacity of SWT to influence underlying pathophysiological processes in various musculoskeletal conditions as demonstrated through changes in imaging.
The dosage parameters of SWT had no clear influence on the imaging outcomes. Also, the utilization of radiological guidance and local anesthesia is questionable. However, the size of lesion is found to be a potential predictor for change in response to SWT.
The dosage parameters of SWT had no clear influence on the imaging outcomes. Also, the utilization of radiological guidance and local anesthesia is questionable. However, the size of lesion is found to be a potential predictor for change in response to SWT.
Funding, acknowledgements: None
Keywords: Extracorporeal shockwave therapy, Imaging, Musculoskeletal
Topic: Musculoskeletal
Did this work require ethics approval? No
Institution: N/A
Committee: N/A
Reason: This study is a systematic review
All authors, affiliations and abstracts have been published as submitted.
