This systematic review and meta-analysis aimed to investigate the effect of ESWT on pain, pressure pain threshold (PPT), and functional disability in patients with SIJ dysfunction.
PubMed, Cochrane, PEDro, Scopus, Web of Science, and Google Scholar databases were searched for randomized controlled trials (RCTs) from inception until August 2024, and forward and backward searches were also conducted to identify any additional studies. Two reviewers independently assessed the titles and abstracts of the retrieved articles, and another two reviewers screened the full texts of the potentially eligible articles. The risk of bias in the included studies was assessed using the PEDro scale, and a quantitative analysis was performed when possible.
A total of six RCTs were included, involving 275 patients with SIJ dysfunction. Most studies were rated as good or fair quality, with only one rated as poor. The pain score (SMD-0.76; 95% CI -2.39, 0.88; P = 0.36), PPT (SMD-0.88; 95% CI -3.77, 2.01; P = 0.55), and functional disability (SMD 1.41; 95% CI -0.34, 3.17; P = 0.11) outcomes were not statistically significant in the short-term; however, the functional disability was statistically significant in the medium term (SMD-14.32; 95% CI -23.18, -5.46; P = 0.002). No serious adverse events were reported.
The meta-analysis suggests that ESWT improved the functional disability level in the medium term but showed no significant effect on all other outcomes in the short term in patients with SIJ. These findings should be interpreted cautiously due to the low methodological quality, the limited number of included studies, heterogeneity in the treatment methods, and lack of long-term follow-up. Therefore, further high-quality RCTs with larger sample sizes, standardized treatment methods, and longer follow-ups are needed to determine the optimal protocol in the future.
The current evidence suggests that ESWT may be a promising treatment option for improving functional disability in the medium term in patients with SIJ dysfunction. However, future RCTs should explore the long-term effects of ESWT and establish standardized treatment protocols and application methods to confirm its efficacy.
sacroiliac joint
systematic review
