Clinical efficacy of extracorporeal shockwave therapy for knee osteoarthritis: a systematic review and meta-regression of randomized controlled trials. (September 2019)

• Record Type: Journal Article
• Authors: Liao, Chun-De; Tsauo, Jau-Yih; Liou, Tsan-Hon; Chen, Hung-Chou; Huang, Shih-Wei
• Is Part Of: Clinical rehabilitation. Volume 33:Number 9(2019)
• Page Start: 1419
• Page End: 1430
• Publication Date: 2019-09
• Subjects: Extracorporeal shockwave therapy -- knee osteoarthritis -- pain -- function outcome; Medical rehabilitation -- Periodicals; 617.03
• DOI: 10.1177/0269215519846942
• Languages: English
• ISSNs: 0269-2155

Abstract

Objective: This study determined the clinical efficacy of extracorporeal shockwave therapy and the predictors of its efficacy for knee osteoarthritis. Data Sources: Electronic databases and search engines, namely MEDLINE, PubMed, EMBASE, Cochrane Library Database, Physiotherapy Evidence Database (PEDro), China Academic Journals Full-text Database, and Google Scholar, were searched until 5 March 2019, for randomized controlled trials without restrictions on language and publication year. Review Methods: Eligible trials and extracted data were identified by two independent investigators. The included articles were subjected to a meta-analysis and risk of bias assessment. Outcomes of interest included treatment success rate, pain, and physical function outcomes. A meta-regression analysis was performed to determine the predictors of treatment outcomes following shockwave therapy. Results: We included 50 trials (4844 patients) with a median (range) PEDro score of 6 (5–9). Meta-analyses results revealed an overall significant effect favoring shockwave therapy on the treatment success rate (odds ratio 3.22, 95% confidence interval (CI) 2.21–4.69, P < 0.00001; heterogeneity ( I 2 ) = 62%), pain reduction (standardized mean difference (SMD) −2.02, 95% CI −2.38 to −1.67, P < 0.00001; I 2 = 95%), and Western Ontario and McMaster Universities Osteoarthritis Index function outcome (SMD −2.71, 95% CI −3.50 to −1.92, P < 0.00001; I 2 = 97%). Follow-up duration and energy flux density were independent significant predictors of shockwave efficacy. Conclusion: Shockwave therapy is beneficial for knee osteoarthritis. Shockwave dosage, particularly the energy level and intervention duration, may have different contributions to treatment efficacy.