1
|
Liao PC, Chou SH, Shih CL. A systematic review of the use of shockwave therapy for knee osteoarthritis. J Orthop 2024; 56:18-25. [PMID: 38765896 PMCID: PMC11096685 DOI: 10.1016/j.jor.2024.04.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 04/23/2024] [Accepted: 04/28/2024] [Indexed: 05/22/2024] Open
Abstract
Introduction Previous studies assessed the effect of extracorporeal shockwave therapy (ESWT) for knee osteoarthritis (OA) among different situations. Thus, results from a meta-analysis regarding this topic may not be reliable due to heterogeneity. Methods A systematic review was conducted on three internet databases, namely Cochrane Library, PubMed, and Embase, gathering pertinent papers from their establishment to March 2024. The search phrases were as follows: "shockwave" OR "shock wave" OR "extracorporeal shockwave" OR "Extracorporeal Shockwave Therapy [MeSH Term]" AND "knee" AND ("osteoarthritis" OR "arthritis" OR "arthritic" OR "osteoarthritis [MeSH term]"). Results Twenty-four articles (n = 888) were included, with the resulting conclusions demonstrating that ESWT was effective for knee OA compared with sham ESWT; however, ESWT was not effective for patients with severe knee OA. Patients receiving higher energy or higher shock number had significant improvement than those receiving lower energy or less shock number, respectively. Adding ESWT in isokinetic muscular strengthening exercises (IMSE) was more effective than IMSE alone. The efficacy of ESWT was better than other therapies, including intravenously applied prostacyclin and bisphosphonate, corticosteroid injection, kinesiotherapy, hyaluronic acid injection, platelet-rich plasma injection, and physiotherapy. Conclusions This review demonstrated that ESWT was effective for knee OA. Higher energy and more shock numbers could obtain better efficacy. ESWT could be used as a replacement for some other therapies.
Collapse
Affiliation(s)
- Po-Cheng Liao
- Surgical Intensive Care Unit, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, 600, Taiwan
| | - Shih-Hsiang Chou
- Department of Orthopedics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, 807, Taiwan
| | - Chia-Lung Shih
- Clinical Research Center, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, 600, Taiwan
| |
Collapse
|
2
|
Cp A, Jayaraman K, Babkair RA, Nuhmani S, Nawed A, Khan M, Alghadir AH. Effectiveness of extracorporeal shock wave therapy on functional ability in grade IV knee osteoarthritis - a randomized controlled trial. Sci Rep 2024; 14:16530. [PMID: 39020015 PMCID: PMC11254909 DOI: 10.1038/s41598-024-67511-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 07/11/2024] [Indexed: 07/19/2024] Open
Abstract
Extracorporeal shockwave therapy (ESWT) is a non-invasive physical therapy intervention that has emerged in the recent past to address the upswing of osteoarthritis (OA). However, insufficient evidence is present to prove the efficacy of ESWT on grade IV knee osteoarthritis (KOA). The present study aimed to examine the effects of ESWT on functional ability in patients suffering from grade IV KOA. Thirty volunteers aged 45-60 years with grade IV primary KOA diagnosed by an orthopaedic surgeon based on the Kellgren-Lawrence score participated in the study. The participants were equally and randomly divided into two groups (i.e. experimental and control), with 15 participants in each group. The participants in the control group performed conventional physiotherapy (CPT) that included ultrasound therapy, isometric quadriceps, SLR and isometric hip adductor strengthening exercises. The participants in the experimental group received ESWT in addition to CPT. Lower extremity functional scale (LEFS) score was measured before and after the four weeks of intervention. In both groups, a statistically significant (p = 0.001) improvement in LEFS was observed. In the experimental groups, it improved by 81.92% and in the control groups by 48.15%. A statistically significant (p < 0.001) difference was observed in LEFS post-intervention values between both groups. As demonstrated by our trial results, the addition of ESWT to the CPT program will yield beneficial results in ameliorating the functional disability in patients with primary KOA (grade IV). Further studies are needed to confirm and apply these findings to a larger cohort.
Collapse
Affiliation(s)
- Arshed Cp
- Department of Physiotherapy, AWH Special College, Kozhikode, Affiliated to Kerala University of Health Sciences, Kozhikode, India
| | - Kavitha Jayaraman
- Department of Physiotherapy, AWH Special College, Kozhikode, Affiliated to Kerala University of Health Sciences, Kozhikode, India
| | | | - Shibili Nuhmani
- Department of Physical Therapy, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Alvina Nawed
- Department of Rehabilitation Science, Jamia Hamdard, New Delhi, India
| | - Masood Khan
- Rehabilitation Research Chair, Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia.
| | - Ahmad H Alghadir
- Rehabilitation Research Chair, Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| |
Collapse
|
3
|
Zhou Q, Chen J. A critical overview of systematic reviews and meta-analyses of extracorporeal shockwave therapy for knee osteoarthritis. Asian J Surg 2024; 47:2975-2984. [PMID: 38290944 DOI: 10.1016/j.asjsur.2024.01.127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 11/20/2023] [Accepted: 01/19/2024] [Indexed: 02/01/2024] Open
Abstract
Knee Osteoarthritis (KOA) has become a serious health issue for elderly patients. Several systematic reviews (SRs) and Meta-Analyses (MAs) have reported extracorporeal shockwave therapy (ESWT) has widely been used in the treatment of KOA. This overview aims to summarize and evaluate the available evidence for the efficacy of ESWT for KOA. Eight databases were searched from inception to December 4, 2022. The methodological quality of the included SRs/MAs was assessed by Assessing the Methodological Quality of Systematic Reviews 2 (AMSTAR 2) and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) tool was used to assess the quality of the included studies in terms of outcome indicators. Eight SRs/MAs were finally included in this study. The results of the methodological quality of the included SRs/MAs were generally unsatisfactory. The limitations were a lack of explaining the reasons for selection, a list of excluded literature, reporting bias assessment, and reporting the potential sources of conflict of interest. A total of 49 outcome indicators were assessed by using the GRADE tool. Only 3 items were assessed as moderate quality and the remaining indicators were rated as low and very low. Limitations were the most common downgraded factors. ESWT is regarded as a safe and therapeutically effective non-pharmacological method for the treatment of KOA. However, the reliability of the results is affected by the generally low methodological and evidential quality of the included SRs/MAs. Future researchers should improve the quality of original studies and SRs/MAs to provide a higher level of evidence-based medical evidence.
Collapse
Affiliation(s)
- Qinxin Zhou
- Department of Orthopaedic Surgery, Shaoxing Hospital of Traditional Chinese Medicine, Shaoxing, 312000, People's Republic of China.
| | - Jixin Chen
- Department of Orthopaedic Surgery, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, 300381, People's Republic of China
| |
Collapse
|
4
|
Tang P, Wen T, Lu W, Jin H, Pan L, Li H, Zeng B, Zhou Y, Xiao W, Li Y. The efficacy of extracorporeal shock wave therapy for knee osteoarthritis : an umbrella review. Int J Surg 2024; 110:2389-2395. [PMID: 38668665 PMCID: PMC11020044 DOI: 10.1097/js9.0000000000001116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 01/09/2024] [Indexed: 04/29/2024]
Abstract
BACKGROUND An umbrella review was conducted to compare the effectiveness of extracorporeal shock wave therapy (ESWT) versus non-ESWT in the treatment of knee osteoarthritis (KOA). MATERIALS AND METHODS Three databases including PubMed, Embase and Web of science were searched up to September 2023. Literature screening, quality evaluation, and data extraction were performed according to inclusion and exclusion criteria. Meta-analysis of outcome indicators was performed using Revman 5.4 software. RESULTS A total of eight meta-analysis were included in this umbrella review. All meta-analysis were graded against a Measurement Tool to Assess Systematic Reviews 2 (AMSTAR 2) and scored between 8 and 11. Compared to the sham group, the ESWT group showed better results in WOMAC (Western Ontario and McMaster Universities Arthritis Index) [mean difference (MD)=-2.94, 95% CI: -5.52, -0.37, P=0.03, I²=60%], Visual Analog Scale (VAS) (MD=-2.0, 95% CI: -2.5, -1.5, P<0.01, I²=0%), range of motion (ROM) (MD=17.55, 95% CI: 13.49, 21.61, P<0.00001, I²=0%), and Lequesne index (MD=-2.85, 95% CI: -3.64, -2.07, P<0.00001, I²=48%). CONCLUSION Based on the results of our analysis, ESWT is now an effective therapy for improving pain and function in patients with KOA.
Collapse
Affiliation(s)
- Peiyuan Tang
- Departments ofOrthopedics
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Ting Wen
- Departments ofOrthopedics
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Wenhao Lu
- Departments ofOrthopedics
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Hongfu Jin
- Departments ofOrthopedics
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Linyuan Pan
- Departments ofOrthopedics
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Hengzhen Li
- Departments ofOrthopedics
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Biyun Zeng
- Departments ofOrthopedics
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | | | - Wenfeng Xiao
- Departments ofOrthopedics
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Yusheng Li
- Departments ofOrthopedics
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| |
Collapse
|
5
|
Hu F, Wang C, Du Y, Guo Z, Zhang K, Ma Y, Yang Y, Gong X, Wang H, Liu P, Shi W. Medial Patellofemoral Complex Reconstruction (Combined Reconstruction of Medial Patellofemoral Ligament and Medial Quadriceps Tendon-Femoral Ligament) With Semitendinosus Autograft Resulted in Similar Clinical and Radiographic Outcomes to Medial Patellofemoral Ligament Reconstruction in Treating Recurrent Patellar Dislocation. Arthroscopy 2024; 40:1264-1276.e1. [PMID: 37716628 DOI: 10.1016/j.arthro.2023.08.079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 08/17/2023] [Accepted: 08/20/2023] [Indexed: 09/18/2023]
Abstract
PURPOSE To compare clinical and radiographic outcomes of medial patellofemoral ligament reconstruction (MPFL-R) and medial patellofemoral complex reconstruction (MPFC-R) for recurrent patellar dislocation. Outcome measures were compared based on the Insall-Salvati index. METHODS Patients who were diagnosed with recurrent patellar dislocation and underwent either MPFL-R or MPFC-R (combined reconstruction of MPFL and medial quadriceps tendon-femoral ligament) were retrospectively analyzed. Group allocation was based on surgical procedure and patient characteristics were collected. Clinical assessments included patient-reported outcome measures (PROMs) and return-to-sports rates. Minimal clinically important difference analysis was performed. A subgroup analysis of PROMs was carried out between patients with an Insall-Salvati index ≤1.2 versus >1.2. The patellar tilt angle, lateral patellar displacement, and bisect offset ratio were measured pre- and postsurgery. Functional failures and complications were assessed. RESULTS Overall, 70 patients (72 knees) in the MPFL-R group and 58 patients (61 knees) in the MPFC-R group were included. Patient characteristics were comparable between the groups. At a minimum follow-up of 24 (mean, 50.6 ± 22.1) months, all PROMs were substantially improved (P < .001), without significant intergroup differences. The percentages of patients reaching the minimal clinically important difference were similar after MPFL-R and MPFC-R: 98.6% versus 93.4% (International Knee Documentation Committee), 97.2% versus 98.4% (Lysholm), 98.6% versus 100% (Kujala), and 77.8% versus 72.1% (Tegner). The subgroup analysis based on patellar height and the return-to-sport rates also suggested comparable results. Radiographic evaluation demonstrated significantly smaller lateral patellar displacements (P = .004) and bisect offset ratios (P < .001) but similar patellar tilt angles after MPFC-R. Four (5.6%) patients receiving MPFL-R and 2 (3.3%) patients receiving MPFC-R reported recurrence of functional instability, without statistically significant difference. CONCLUSIONS MPFC-R resulted in similar overall clinical and radiographic outcomes to MPFL-R in treating recurrent patellar dislocation. MPFC-R might not provide additional benefits for patients with an Insall-Salvati index >1.2. LEVEL OF EVIDENCE Level IV, therapeutic, retrospective cohort study.
Collapse
Affiliation(s)
- Fengyi Hu
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing, China
| | - Cheng Wang
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing, China
| | - Yingying Du
- Peking University Health Science Center, Beijing, China
| | - Zejing Guo
- Peking University Health Science Center, Beijing, China
| | - Keying Zhang
- Peking University Health Science Center, Beijing, China
| | - Yong Ma
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing, China
| | - Yuping Yang
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing, China
| | - Xi Gong
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing, China
| | - Haijun Wang
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing, China
| | - Ping Liu
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing, China
| | - Weili Shi
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing, China.
| |
Collapse
|
6
|
Wang Z, Xu H, Wang Z, Zhou H, Diao J, Zhang L, Wang Y, Li M, Zhou Y. Effects of externally-applied, non-pharmacological Interventions on short- and long-term symptoms and inflammatory cytokine levels in patients with knee osteoarthritis: a systematic review and network meta-analysis. Front Immunol 2023; 14:1309751. [PMID: 38155966 PMCID: PMC10752972 DOI: 10.3389/fimmu.2023.1309751] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 11/30/2023] [Indexed: 12/30/2023] Open
Abstract
Background With the continuous development of clinical medicine, an increasing number of non-pharmacological interventions have been applied for the treatment of knee osteoarthritis (KOA), with the results of several recent randomized controlled trials (RCTs) showing that a variety of externally-applied, non-pharmacological interventions (EANPI) can improve symptoms and inflammation in patients with KOA. However, the relative benefits and disadvantages of non-drug therapies remain uncertain, and an optimal treatment strategy has not yet been determined. Objective This study applied network meta-analysis (NMA) to compare and rank the effectiveness of EANPI on the short- and long-term clinical symptoms and inflammatory cytokine levels in patients with KOA. Methods Two independent researchers searched online databases and performed manual retrieval of related citations to identify RCTs that met the selection criteria for the network meta-analysis. These researchers retrieved studies indexed from database inception to August 2023 and performed data extraction and assessment of the risk of bias. Results The analysis included 80 RCTs involving 8440 participants and nine externally-applied, non-pharmacological therapies, namely extracorporeal shock wave, radiofrequency, acupotomy, laser therapy, Tuina therapy, kinesio taping, electroacupuncture, platelet-rich plasma injection, and ozone therapy. The treatment courses ranged from 1 to 12 weeks, with follow-up periods ranging from 4 to 24 weeks. The results of the NMA indicated that each non-drug therapy was superior to sham intervention in improving all outcome indicators. Except for the visual analog scale (VAS) and Western Ontario MacMaster (WOMAC) pain outcomes, all non-drug therapies had better efficacy than pharmacological treatments. For short-term VAS and tumor necrosis factor-alpha (TNF-α), extracorporeal shock wave performed better than other therapies (90.2% and 85.2% respectively). Radiofrequency therapy may be the most promising method to reduce long-term VAS, short- and long-term WOMAC pain, and interleukin (IL)-1β level (84.8%, 97.8%, 90.1%, 94.8% respectively). Tuina therapy may be a significant choice for short- and long-term outcomes of WOMAC function and range of motion (ROM). Conclusions The results of the comprehensive comparison of the outcome indicators in 9 different EANPI indicated that radiofrequency and Tuina therapy were more effective and consistently ranked high in improving clinical symptoms in the short and long term. Radiofrequency is effective at relieving pain, and Tuina therapy can be given priority for treatment when hypofunction is the main symptom. EANPI to improve pain symptoms may be related to the regulation of inflammatory cytokine levels, which may be a potential mechanism of action. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?, identifier CRD42023464177.
Collapse
Affiliation(s)
- Zhen Wang
- College of Acupuncture and Massage, Henan University of Chinese Medicine, Zhengzhou, China
| | - Hui Xu
- College of Acupuncture and Massage, Henan University of Chinese Medicine, Zhengzhou, China
- Tuina Department, The Third Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China
| | - Zheng Wang
- College of Acupuncture and Massage, Henan University of Chinese Medicine, Zhengzhou, China
| | - Hang Zhou
- College of Acupuncture and Massage, Henan University of Chinese Medicine, Zhengzhou, China
| | - Jieyao Diao
- College of Acupuncture and Massage, Henan University of Chinese Medicine, Zhengzhou, China
| | - Lijuan Zhang
- Rehabilitation Department, Jiaozuo Coal Industry (Group) Co. Ltd., Central Hospital, Jiaozuo, China
| | - Yu Wang
- College of Computer Science, Xidian University, Xian, China
| | - Miaoxiu Li
- College of Acupuncture and Massage, Shanghai University of Chinese Medicine, Shanghai, China
| | - Yunfeng Zhou
- College of Acupuncture and Massage, Henan University of Chinese Medicine, Zhengzhou, China
| |
Collapse
|
7
|
Feng S, Yu L, Lu P. Analysis of randomized clinical trials on extracorporeal shock wave therapy to improve pain and function in subjects with knee osteoarthritis. Minerva Pediatr (Torino) 2023; 75:934-937. [PMID: 37255399 DOI: 10.23736/s2724-5276.23.07321-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- Shuquan Feng
- Department of Anesthesiology, Kunshan Traditional Chinese Medicine Hospital, Kunshan, China
| | - Ling Yu
- Department of Anesthesiology, Kunshan Traditional Chinese Medicine Hospital, Kunshan, China
| | - Peichun Lu
- Department of Anesthesiology, Kunshan Traditional Chinese Medicine Hospital, Kunshan, China -
| |
Collapse
|
8
|
Walton J, Kozina E, Woo F, Jadidi S. A Review of Patellar Tendinopathy in Athletes Involved in Jumping Sports. Cureus 2023; 15:e47459. [PMID: 38022235 PMCID: PMC10661584 DOI: 10.7759/cureus.47459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2023] [Indexed: 12/01/2023] Open
Abstract
This review article discusses the anatomy and histopathology of the patellar tendon, as well as the risk factors and common interventions for patellar tendinopathy (PT) with a view to guide clinicians in treating athletes with patellar tendon pain. PT, or jumper's knee, refers to a chronic injury to the patellar tendon that affects athletes who engage in jumping and explosive movements. The condition is characterized by degeneration and disorganization of the collagen fibers in the tendon, an increase in mucoid ground substance, and fibroblast proliferation. Risk factors for patellar tendinopathy include participation in jumping sports, a greater counter-movement jump height, and training on hard surfaces. Nonoperative treatments for patellar tendinopathy include relative rest, stretching and strengthening exercises, and correction of biomechanical abnormalities. Surgery and other procedures, such as extracorporeal shockwave therapy (ESWT) and injection therapies, may be considered for patients who do not respond to conservative measures.
Collapse
Affiliation(s)
- John Walton
- Family and Community Medicine, McGaw Medical Center of Northwestern University, Chicago, USA
| | - Erik Kozina
- Orthopedics, University of Illinois at Chicago, Chicago, USA
| | - Frank Woo
- Internal Medicine and Pediatrics, Loyola University Medical Center, Chicago, USA
| | - Shaheen Jadidi
- Sports Medicine, Loyola University Medical Center, Chicago, USA
| |
Collapse
|
9
|
Smith KM, Massey BJ, Young JL, Rhon DI. What are the unsupervised exercise adherence rates in clinical trials for knee osteoarthritis? A systematic review. Braz J Phys Ther 2023; 27:100533. [PMID: 37597491 PMCID: PMC10462806 DOI: 10.1016/j.bjpt.2023.100533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 07/11/2023] [Accepted: 08/04/2023] [Indexed: 08/21/2023] Open
Abstract
BACKGROUND Exercise is an effective intervention for knee osteoarthritis (OA), and unsupervised exercise programs should be a common adjunct to most treatments. However, it is unknown if current clinical trials are capturing information regarding adherence. OBJECTIVE To summarize the extent and quality of reporting of unsupervised exercise adherence in clinical trials for knee OA. METHODS Reviewers searched five databases (PubMed, CINAHL, Medline (OVID), EMBASE and Cochrane). Randomized controlled trials where participants with knee OA engaged in an unsupervised exercise program were included. The extent to which exercise adherence was monitored and reported was assessed and findings were subgrouped according to method for tracking adherence. The types of adherence measurement categories were synthesized. A quality assessment was completed using the Physiotherapy Evidence Database (PEDro) scores. RESULTS Of 3622 abstracts screened, 176 studies met criteria for inclusion. PEDro scores for study quality ranged from two to ten (mean=6.3). Exercise adherence data was reported in 72 (40.9%) studies. Twenty-six (14.8%) studies only mentioned collection of adherence. Adherence rates ranged from 3.7 to 100% in trials that reported adherence. For 18 studies (10.2%) that tracked acceptable adherence, there was no clear superiority in treatment effect based on adherence rates. CONCLUSIONS Clinical trials for knee OA do not consistently collect or report adherence with unsupervised exercise programs. Slightly more than half of the studies reported collecting adherence data while only 40.9% reported findings with substantial heterogeneity in tracking methodology. The clinical relevance of these programs cannot be properly contextualized without this information.
Collapse
Affiliation(s)
- Kristin M Smith
- Science Program in Physical Therapy, Bellin College, Green Bay, WI, USA.
| | - B James Massey
- Science Program in Physical Therapy, Bellin College, Green Bay, WI, USA; Department of Physical Therapy, Wingate University, Wingate, NC, USA
| | - Jodi L Young
- Science Program in Physical Therapy, Bellin College, Green Bay, WI, USA
| | - Daniel I Rhon
- Science Program in Physical Therapy, Bellin College, Green Bay, WI, USA; Department of Rehabilitation Medicine, School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| |
Collapse
|
10
|
Ihrke A. Multimodal Approach to Pain Management in Veterinary Rehabilitation. Vet Clin North Am Small Anim Pract 2023; 53:731-742. [PMID: 37019720 DOI: 10.1016/j.cvsm.2023.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
Abstract
Pain recognition, assessment, and management is a primary focus and an integral part of veterinary rehabilitation. Evidence-based pain mitigation protocols will use both pharmacologic tools and nonpharmacologic methods to create a customized, safe, and effective treatment plan. A multimodal, patient-centered approach will allow for the best outcomes for pain relief and improved quality of life.
Collapse
|
11
|
Şah V. The Short-Term Efficacy of Large-Focused and Controlled-Unfocused (Radial) Extracorporeal Shock Wave Therapies in the Treatment of Hip Osteoarthritis. J Pers Med 2022; 13:jpm13010048. [PMID: 36675709 PMCID: PMC9865373 DOI: 10.3390/jpm13010048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 12/19/2022] [Accepted: 12/23/2022] [Indexed: 12/28/2022] Open
Abstract
Although the classical treatments listed in the guidelines for osteoarthritis are widely used, the majority of patients do not fully recover from their pain. It is a fact that new treatment methods are needed both to relieve pain and restore deteriorated joint function. No study has been found to date that evaluated the efficacy of ESWT in hip OA. This pilot trial is the first in the literature to investigate the comparative effects of the two ESWT types (f-ESWT and r-ESWT) in the treatment of hip OA. Briefly, 148 patients were randomly distributed into the three ESWT groups: focused (f-ESWT), radial (r-ESWT), and sham (s-ESWT). Patients were assessed with the Visual Analog Scale (VAS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores just before the treatment (0 week), just after the treatment (4th week), and 1 month after completion of the treatment (8th week). VAS and all WOMAC scores were significantly reduced at follow-up points (4th and 8th weeks) in both the f-ESWT and r-ESWT groups compared with baseline (0 week) (for all, p < 0.001). Statistical comparisons between the f-ESWT and r-ESWT groups showed that f-ESWT was superior to r-ESWT for the decrease in VAS and WOMAC scores from baseline to the 4th and 8th weeks (p < 0.001 or p < 0.002). Both r-ESWT and f-ESWT were found to have significant treatment efficacy compared with s-ESWT. However, f-ESWT produced a superior improvement in follow-up parameters compared to r-ESWT.
Collapse
Affiliation(s)
- Volkan Şah
- Department of Sports Medicine, University of Yüzüncü Yıl, Van 65040, Turkey
| |
Collapse
|
12
|
Physiotherapeutic Strategies and Their Current Evidence for Canine Osteoarthritis. Vet Sci 2022; 10:vetsci10010002. [PMID: 36669003 PMCID: PMC9863568 DOI: 10.3390/vetsci10010002] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 12/14/2022] [Accepted: 12/17/2022] [Indexed: 12/24/2022] Open
Abstract
Osteoarthritis (OA) is a common and debilitating condition in domestic dogs. Alongside pharmaceutical interventions and weight loss, exercise and physiotherapy (PT) are important measures in maintaining patient mobility and quality of life. Physiotherapy for OA aims to reduce pain, optimize muscular function and maintain joint function. Physiotherapeutic plans typically include PT exercises combined with therapeutic modalities, lifestyle and environmental modifications to improve the patient's overall quality of life and function. Information on therapeutic clinical efficacy of physiotherapeutic measures for canine OA is still very limited. Thus, physiotherapeutic strategies are still primarily based on evidence extrapolated from human protocols tailored to people with OA. The authors propose a simple systematic PT approach for canine OA, prioritizing measures according to simplicity, cost effectiveness and practicality. This guide (the "Physiotherapy Pyramid") aims to provide a clear stratified approach to simplify decision making and planning for owners, veterinarians and veterinary physiotherapists, leading to more straightforward design and implementation of treatment plans. Measures are implemented starting at the base of the pyramid, subsequently progressing to the top, allowing effective and practical interventions to be prioritized. The levels of the pyramid are in ascending order: environmental modification, exercise plan, OA-specific home exercises and treatment by a veterinary physiotherapist.
Collapse
|
13
|
Liu Y, Wu C, Chen C, Zhang L, Xing G, Wu K, Zhao Z, Yin H, Ma Y. Impact of soft tissue around the knee on the efficacy of extracorporeal shockwave therapy in knee osteoarthritis. Medicine (Baltimore) 2022; 101:e32334. [PMID: 36550919 PMCID: PMC9771275 DOI: 10.1097/md.0000000000032334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Knee osteoarthritis (KOA) is the leading cause of knee pain in middle-aged and older individuals. Extracorporeal shockwave therapy (ESWT) has been applied to treat patients with KOA to reduce pain and improve function. Patients (n = 123) diagnosed with KOA who received ESWT were selected to participate in this study, and were grouped according to their body mass index (BMI). The treatment parameters were as follows: 8000 pulses, 2.0 bar, 0.25 mJ/mm2, and 6 Hz/s once per week for 8 weeks. The visual analog scale (VAS), Lequesne index, and Western Ontario and McMaster University Osteoarthritis Index (WOMAC) were measured to assess knee pain and functional recovery according to BMI groups. Radiographs were used to measure the richness of the soft tissue around the knee joint. The correlation between the distribution of tissue, pain, and functional improvement was analyzed using the receiver operator characteristic curve. All the patients showed a reduction in pain after treatment compared to that before treatment (P < .01). As measured by the VAS, the Lequesne and WOMAC indexes, after the intervention, the pain and functional index of the overweight and above BMI group improved to a greater extent than that of the normal or below normal BMI group (P < .01). The area under the curve showed, with VAS as the demarcation criterion, when the tibial plateau soft tissue ratio, femoral intercondylar apex soft tissue ratio, and medial tibial soft tissue ratio exceeded 1.538, 1.534, and 1.296, respectively, the patient's pain relief was more pronounced the ESWT treatment was better. With pain in WOMAC as the demarcation criterion, the tibial plateau soft tissue ratio, femoral intercondylar apex soft tissue ratio, and medial tibial soft tissue ratio also are positively correlated with pain relief in patients. When the Lequesne and WOMAC scores were the demarcation criteria, the patients' function improved significantly when the patella apical soft tissue ratio exceeded 2.401 and 2.635, respectively. ESWT can effectively alleviate pain and improve knee function in patients with KOA, and the soft tissue around the knee joint should also be an important reference factor in KOA treatment.
Collapse
Affiliation(s)
- Yu Liu
- Department of Orthopedics, Hospital of Zhejiang People’s Armed Police (PAP), Hangzhou, China
| | - Chunhu Wu
- Department of Orthopedics, Hospital of Zhejiang People’s Armed Police (PAP), Hangzhou, China
| | - Changsong Chen
- Department of Orthopedics, Hospital of Zhejiang People’s Armed Police (PAP), Hangzhou, China
| | - Lianhe Zhang
- Department of Orthopedics, Hospital of Zhejiang People’s Armed Police (PAP), Hangzhou, China
| | - Gengyan Xing
- Department of Orthopaedics, The Third Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Kun Wu
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China
| | - Zhe Zhao
- Department of Orthopaedics, The Third Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Huadong Yin
- Department of Orthopedics, Hospital of Zhejiang People’s Armed Police (PAP), Hangzhou, China
| | - Yuhai Ma
- Department of Orthopedics, Hospital of Zhejiang People’s Armed Police (PAP), Hangzhou, China
- * Correspondence: Yuhai Ma, Department of Orthopedics, Hospital of Zhejiang People’s Armed Police (PAP), Hangzhou 310051, China (e-mail: )
| |
Collapse
|
14
|
Silva AC, Almeida VS, Veras PM, Carnaúba FRN, Filho JE, Garcia MAC, Fonseca DS. Effect of extracorporeal shock wave therapy on pain and function in patients with knee osteoarthritis: a systematic review with meta-analysis and grade recommendations. Clin Rehabil 2022; 37:760-773. [PMID: 36524275 DOI: 10.1177/02692155221146086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Objective To investigate extracorporeal shock wave therapy effect on knee osteoarthritis compared to a sham or kinesiotherapy by a systematic review and meta-analysis of randomized clinical trials. Data Sources The search was performed in: Cochrane Library, PubMed, PEDro, Web of Science, EMBASE, Scopus, LILACS, and Scielo. Review methods We performed the online search until October, 2022. The following terms were used (Osteoarthritis) AND (“knee joint”) AND (“Extracorporeal Shockwave Therapy”). Eligibility criteria: (1) randomized clinical trials; (2) effects comparison of shockwave therapy to a sham or kinesiotherapy in individuals with knee osteoarthritis; (3) pain and physical function as outcome variables. Risk of bias assessed using the PEDro scale. PROSPERO registration (CRD42021235597). Results We identified 4217 studies, and 12 were included in the qualitative synthesis and the meta-analysis, totaling 403 individuals submitted to the intervention and 331 control individuals. Compared to sham, shockwave was favored in short-term for the function outcome (SMD = −1.93; 95%CI: [−2.77; −1.09]; I² = 83%; P < 0.01). For the pain outcome, the shockwave was favored in the short (MD = −2.05; 95%CI: [−2.59; −1.51]; I² = 84%; P < 0.01), medium (MD = −3.46; 95%CI: [−4.03; −2.89]; I² = 0%; P < 0.01) and long-term (MD = −2.01; 95%CI: [−3.36; −0.65]; I² = 98%; P < 0.01). The association with kinesiotherapy was favored in the short term for the function outcome (SMD = -1.88; 95%CI: [−2.98; −0.78]; I² = 94%; P < 0.01) and favored for the pain outcome in the short (MD = −1.44; 95%CI: [−1.81; −1.07]; I² = 37%; P = 0.14), medium (MD = −1,31; 95%CI: [−1.76; −0,85]; I² = 0%; P = 0.41), and long terms (MD = −1.63; 95%CI: [−1.73; −1.52]; I² = 0%; P = 0.43). Conclusion Shockwave therapy may improve functionality in patients with knee osteoarthritis in the short term and pain in all follow-up moments, compared with sham. When associated to kinesiotherapy, it may improve function in the short term and pain in all follow-up time points, although improvement in pain may not be clinically significant.
Collapse
Affiliation(s)
- AC Silva
- Programa de Graduação em Fisioterapia, Faculdade de Fisioterapia, Universidade Federal de Juiz de Fora, Juiz de Fora, Brasil
| | - VS Almeida
- Programa de Graduação em Fisioterapia, Faculdade de Fisioterapia, Universidade Federal de Juiz de Fora, Juiz de Fora, Brasil
| | - PM Veras
- Hospital Universitário, Universidade Federal de Juiz de Fora, Juiz de Fora, Brasil
| | - FRN Carnaúba
- Departamento de Fisioterapia, Instituto de Ciências da Vida, Universidade Federal de Juiz de Fora, Governador Valadares, Brasil
| | - JE Filho
- Programa de Pós-graduação em Educação Física, Faculdade de Educação Física, Universidade Federal de Juiz de Fora, Juiz de Fora, Brasil
| | - MAC Garcia
- Departamento de Fisiologia, Instituto de Ciências Biológicas, Programa de Pós-graduação em Ciências da Reabilitação e Desempenho Físico Funcional, Universidade Federal de Juiz de Fora, Juiz de Fora, Brasil
| | - DS Fonseca
- Programa de Pós-graduação em Ciências da Reabilitação e Desempenho Físico Funcional, Faculdade de Fisioterapia, Universidade Federal de Juiz de Fora, Juiz de Fora, MG, Brasil
| |
Collapse
|
15
|
Wang Z, Efferth T, Hua X, Zhang XA. Medicinal plants and their secondary metabolites in alleviating knee osteoarthritis: A systematic review. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2022; 105:154347. [PMID: 35914361 DOI: 10.1016/j.phymed.2022.154347] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 06/30/2022] [Accepted: 07/17/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND With the increasing ages of the general population, the incidence of knee osteoarthritis (KOA) is also rising, and KOA has become a major health problem worldwide. Recently, medicinal plants and their secondary metabolites have gained interest due to their activity in treating KOA. In this paper, a comprehensive systematic review of the literature was performed concerning the effects of medicinal plant extracts and natural compounds against KOA in recent years. The related molecular pathways of natural compounds against KOA were summarized, and the possible crosstalk among components in chondrocytes was discussed to propose possible solutions for the current situation of treating KOA. PURPOSE This review focused on the molecular mechanisms by which medicinal plants and their secondary metabolites act against KOA. METHODS Literature searches were performed in the PUBMED, Embase, Science Direct, and Web of Science databases for a 10-year period from 2011 to 2022 with the search terms "medicinal plants," "bioactive compounds," "natural products," "phytochemical," "knee osteoarthritis," "knee joint osteoarthritis," "knee osteoarthritis," "osteoarthritis of the knee," and "osteoarthritis of knee joint." RESULTS According to the results, substantial plant extracts and secondary metabolites show a positive effect in fighting KOA. Plant extracts and their secondary metabolites can affect the diagnostic and prognostic biomarkers of KOA. Natural products inhibit the expression of MMP1, MMP3, MMP19, syndecan IV, ADAMTS-4, ADAMTS-5, iNOS, COX-2, collagenases, IL-6, IL-1β, and TNF-α in vitro and in vivo and . Cytokines also upregulate the expression of collagen II and aggrecan. The main signaling pathways affected by the extracts and isolated compounds include AMPK, SIRT, NLRP3, MAPKs, PI3K/AKT, mTOR, NF-κB, WNT/β-catenin, JAK/STAT3, and NRF2, as well as the cell death modes apoptosis, autophagy, pyroptosis, and ferroptosis. CONCLUSION The role of secondary metabolites in different signaling pathways supplies a better understanding of their potential to develop further curative options for KOA.
Collapse
Affiliation(s)
- Zhuo Wang
- School of Kinesiology, Shenyang Sport University, No. 36 Jinqiansong East Road, Shenyang, China
| | - Thomas Efferth
- Department of Pharmaceutical Biology, Institute of Pharmaceutical and Biomedical Sciences, Johannes Gutenberg University, Mainz, Germany
| | - Xin Hua
- College of Life Science, Northeast Forestry University, No. 26 Hexing Road, Harbin, China; Key Laboratory of Saline-alkali Vegetation Ecology Restoration, Ministry of Education, Northeast Forestry University, Harbin, China.
| | - Xin-An Zhang
- School of Kinesiology, Shenyang Sport University, No. 36 Jinqiansong East Road, Shenyang, China.
| |
Collapse
|
16
|
de Menezes AB, Back CGN, Driusso P, Liebano RE. How to report parameters and procedures for shockwave therapy in musculoskeletal disorders: A narrative review. Medicine (Baltimore) 2022; 101:e29664. [PMID: 35960087 PMCID: PMC9371498 DOI: 10.1097/md.0000000000029664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Shockwave therapy (SWT) has been successful in the management of musculoskeletal conditions. The limitations of the use of SWT in clinical practice regard a lack of familiarity with the device and the lack of uniformity in information reported in scientific publications. Standardization in the reporting of these parameters could facilitate the reproduction and interpretation of data in future studies. Most studies fail to offer a detailed description of the parameters. Therefore, the aim of the present paper is to prepare a report on how to standardize the presentation of this information and serve a reference guide to report physical parameters and procedures of SWT when used on patients with musculoskeletal disorders. The terms were selected from the Medical Subject Headings database of controlled vocabulary. An extensive process of systematic searching of databases was performed, after which experts met and discussed on the main findings, and a consensus was achieved. SWT parameters were described, including the physiological meaning and clinical relevance of each parameter. Also, the description of patient and equipment positioning was added. The consensus-based guideline on how to report SWT parameters for the treatment of musculoskeletal conditions was developed to help clinicians and researchers.
Collapse
Affiliation(s)
- Athilas Braga de Menezes
- Physiotherapeutic Resources Laboratory, Department of Physical Therapy, Federal University of Sao Carlos (UFSCar), Brazil
- *Correspondence: Athilas Braga de Menezes, Physiotherapeutic Resources Laboratory, Department of Physical Therapy, Federal University of Sao Carlos (UFSCar), WA Luiz highway, São Carlos, Brazil (e-mail: )
| | - Cláudio Gregório Nuerberg Back
- Physiotherapeutic Resources Laboratory, Department of Physical Therapy, Federal University of Sao Carlos (UFSCar), Brazil
| | - Patricia Driusso
- Women’s health Research Laboratory, Department of Physical Therapy, Federal University of São Carlos (UFSCar), Brazil
| | - Richard Eloin Liebano
- Physiotherapeutic Resources Laboratory, Department of Physical Therapy, Federal University of Sao Carlos (UFSCar), Brazil
| |
Collapse
|
17
|
Oliveira S, Andrade R, Valente C, Espregueira-Mendes J, Silva F, Hinckel BB, Carvalho Ó, Leal A. Mechanical-based therapies may reduce pain and disability in some patients with knee osteoarthritis: A systematic review with meta-analysis. Knee 2022; 37:28-46. [PMID: 35660536 DOI: 10.1016/j.knee.2022.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 05/09/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Mechanical-based therapies are not yet recommended to manage osteoarthritis (OA). This systematic review and meta-analysis aim to assess the effects of passive mechanical-based therapies (isolated or combined with other therapies) on patients with knee OA compared to placebo, other isolated or combined interventions. METHODS Pubmed, Cochrane, Web of Science and EMBASE were searched up to December 2020. We included randomized and non-randomized trials using therapeutic ultrasound, phonophoresis, extracorporeal shockwave therapy (ESWT) and vibration (single or combined with other therapies) compared to placebo, and/or other physical therapies groups. Biochemical, patient-reported, physical and imaging outcome measures were retrieved. We judged risk of bias using the RoB2 tool for randomized studies, the ROBINS-I tool for non-randomized studies, and the GRADE to interpret certainty of results. RESULTS We included 77 clinical studies. Ultrasound and ESWT statistically improved pain and disability comparing to placebo (combined or not with other therapies), and when added to other therapies versus other therapies alone. Ultrasound was statistically inferior to phonophoresis (combined or not with other therapies) in reducing pain and disability for specific therapeutic gels and/or combined therapies. Vibration plus exercise statistically improved pain relief and function versus exercise alone. All meta-analyses showed very-low certainty of evidence, with 15 of 42 (38%) pooled comparisons being statistically significant (weak to large effect). CONCLUSIONS Despite the inconsistent evidence with very-low certainty, the potential benefits of passive mechanical-based therapies should not be disregard and cautiously recommended that clinicians might use them in some patients with knee OA.
Collapse
Affiliation(s)
- Sofia Oliveira
- Center for MicroElectroMechanical Systems (CMEMS‑UMINHO), University of Minho, Azurém Campus, 4800‑058 Guimarães, Portugal; LABBELS - Associate Laboratory, Braga, Guimarães, Portugal.
| | - Renato Andrade
- Clínica Espregueira - FIFA Medical Centre of Excellence, Porto, Portugal; Dom Henrique Research Centre, Porto, Portugal; Porto Biomechanics Laboratory (LABIOMEP), Faculty of Sports, University of Porto, Porto, Portugal.
| | - Cristina Valente
- Clínica Espregueira - FIFA Medical Centre of Excellence, Porto, Portugal; Dom Henrique Research Centre, Porto, Portugal.
| | - João Espregueira-Mendes
- Clínica Espregueira - FIFA Medical Centre of Excellence, Porto, Portugal; Dom Henrique Research Centre, Porto, Portugal; ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal; 3B's Research Group‑Biomaterials, Biodegradables and Biomimetics, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, University of Minho, AvePark, Parque de Ciência e Tecnologia, Zona Industrial da Gandra, Barco, 4805‑017 Guimarães, Portugal; School of Medicine, University of Minho, Braga, Portugal.
| | - Filipe Silva
- Center for MicroElectroMechanical Systems (CMEMS‑UMINHO), University of Minho, Azurém Campus, 4800‑058 Guimarães, Portugal; LABBELS - Associate Laboratory, Braga, Guimarães, Portugal.
| | - Betina B Hinckel
- Department of Orthopaedic Surgery, William Beaumont Hospital, Royal Oak, MI, USA.
| | - Óscar Carvalho
- Center for MicroElectroMechanical Systems (CMEMS‑UMINHO), University of Minho, Azurém Campus, 4800‑058 Guimarães, Portugal; LABBELS - Associate Laboratory, Braga, Guimarães, Portugal.
| | - Ana Leal
- Center for MicroElectroMechanical Systems (CMEMS‑UMINHO), University of Minho, Azurém Campus, 4800‑058 Guimarães, Portugal; LABBELS - Associate Laboratory, Braga, Guimarães, Portugal; Dom Henrique Research Centre, Porto, Portugal.
| |
Collapse
|
18
|
Comparative Effectiveness of Focused Extracorporeal versus Radial Extracorporeal Shockwave Therapy for Knee Osteoarthritis—Randomized Controlled Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159001. [PMID: 35897371 PMCID: PMC9332723 DOI: 10.3390/ijerph19159001] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 07/17/2022] [Accepted: 07/22/2022] [Indexed: 11/17/2022]
Abstract
Both focused extracorporeal shockwave (f-ESWT) and radial extracorporeal shockwave therapy (r-ESWT) can alleviate symptoms in patients with knee osteoarthritis, but no trials have directly compared f-ESWT with r-ESWT for knee osteoarthritis. This study aimed to compare the effectiveness of f-ESWT and r-ESWT on knee osteoarthritis. Forty-two patients with bilateral knee osteoarthritis were randomly assigned to receive three sessions of either f-ESWT or r-ESWT at 1-week intervals. The patients were evaluated at baseline and at 4 and 8 weeks after the final treatment. The primary outcome was the change in pain intensity, as measured on the visual analog scale (VAS). Secondary outcomes included the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), range of motion of the knee joint, and the 6-minute walk test. At the end of 4 weeks, the VAS score was substantially reduced in both groups (f-ESWT, −4.5 ± 2.5 points; r-ESWT, −2.6 ± 2.0 points), with a greater reduction in the f-ESWT group. Both groups showed significant improvement in secondary outcomes; however, the f-ESWT group yielded greater improvement in the VAS score, WOMAC score, and 6-minute walk test. Our results showed that f-ESWT was more effective than r-ESWT in improving pain and physical function in patients with knee osteoarthritis.
Collapse
|
19
|
Xuan J, Shao R. A commentary on "The efficacy and safety of extracorporeal shockwave therapy in knee osteoarthritis: A systematic review and meta-analysis" [Int J Surg. 2020 Jan 21; 75: 24-34]. Int J Surg 2022; 103:106701. [PMID: 35705174 DOI: 10.1016/j.ijsu.2022.106701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 06/05/2022] [Indexed: 10/18/2022]
Affiliation(s)
- Jiangwei Xuan
- Department of Orthopaedic Surgery, Zhuji People's Hospital of Zhejiang Province and Zhuji Affiliated Hospital of Wenzhou Medical University, Zhuji, 311800, China
| | - Ruyi Shao
- Department of Orthopaedic Surgery, Zhuji People's Hospital of Zhejiang Province and Zhuji Affiliated Hospital of Wenzhou Medical University, Zhuji, 311800, China.
| |
Collapse
|
20
|
Deep Learning-Based Multimodal 3 T MRI for the Diagnosis of Knee Osteoarthritis. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:7643487. [PMID: 35529263 PMCID: PMC9076302 DOI: 10.1155/2022/7643487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 04/04/2022] [Indexed: 11/17/2022]
Abstract
The objective of this study was to investigate the application effect of deep learning model combined with different magnetic resonance imaging (MRI) sequences in the evaluation of cartilage injury of knee osteoarthritis (KOA). Specifically, an image superresolution algorithm based on an improved multiscale wide residual network model was proposed and compared with the single-shot multibox detector (SSD) algorithm, superresolution convolutional neural network (SRCNN) algorithm, and enhanced deep superresolution (EDSR) algorithm. Meanwhile, 104 patients with KOA diagnosed with cartilage injury were selected as the research subjects and underwent MRI scans, and the diagnostic performance of different MRI sequences was analyzed using arthroscopic results as the gold standard. It was found that the image reconstructed by the model in this study was clear enough, with minimum noise and artifacts, and the overall quality was better than that processed by other algorithms. Arthroscopic analysis found that grade I and grade II lesions concentrated on patella (26) and femoral trochlear (15). In addition to involving the patella and femoral trochlea, grade III and grade IV lesions gradually developed into the medial and lateral articular cartilage. The 3D-DS-WE sequence was found to be the best sequence for diagnosing KOA injury, with high diagnostic accuracy of over 95% in grade IV lesions. The consistency test showed that the 3D-DESS-WE sequence and T2∗ mapping sequence had a strong consistency with the results of arthroscopy, and the Kappa consistency test values were 0.748 and 0.682, respectively. In conclusion, MRI based on deep learning could clearly show the cartilage lesions of KOA. Of different MRI sequences, 3D-DS-WE sequence and T2∗ mapping sequence showed the best diagnosis results for different degrees of KOA injury.
Collapse
|
21
|
Rahim M, Ooi FK, Shihabudin MT, Chen CK, Musa AT. The Effects of Three and Six Sessions of Low Energy Extracorporeal Shockwave Therapy on Graft Incorporation and Knee Functions Post Anterior Cruciate Ligament Reconstruction. Malays Orthop J 2022; 16:28-39. [PMID: 35519531 PMCID: PMC9017919 DOI: 10.5704/moj.2203.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 09/01/2021] [Indexed: 11/05/2022] Open
Abstract
Introduction One session of high energy extracorporeal shockwave therapy (ESWT) was found to improve the healing of anterior cruciate ligament (ACL) after reconstruction in animal and human studies. This study investigated the effects of three and six sessions of low energy ESWT on graft incorporation and knee functions post ACL reconstruction in humans. Materials and methods Thirty participants with ACL injuries were recruited and assigned equally into three groups with 10 participants per group (n=10). Participants in the control group received physiotherapy alone without low energy ESWT. Participants in the 3ESWT group underwent three sessions of low energy ESWT (one session per week) combined with physiotherapy, and participants in the 6ESWT group received six sessions of low energy ESWT (one session per week) combined with physiotherapy. However, five participants were lost to follow-up. Evaluations of graft incorporation of the tibial tunnel using magnetic resonance (MRI) and Lysholm score were carried out before ACL reconstruction and after six months post ACL reconstruction. Results The number of grafts with partial incorporation in the tibia tunnel in 6ESWT was significantly higher compared with the number of grafts with non-incorporation at six months post-operatively, X2 (1, N=9) =5.44, p =0.02. However, there was no significant difference between frequencies of graft incorporation in tibia tunnel in the control and 3ESWT groups, X2 (1, N=7) =3.57, p =0.06 and X2 (1, N=9) =2.78, p =0.10, respectively at 6 months postoperatively. Lysholm scores were significantly higher at 6 months post ACL reconstruction compared to the baseline value for each group (p<0.002, respectively). However, there was no significant difference in the Lysholm score between each group (F = 2.798, p = 0.083). Conclusions Six sessions of low energy ESWT improved graft incorporation in the tibial tunnel. Both three and six sessions of low energy of ESWT does not affect the knee function score at six months post ACL reconstruction.
Collapse
Affiliation(s)
- M Rahim
- Exercise and Sports Science Programme, Universiti Sains Malaysia, Kubang Kerian, Malaysia
- School of Rehabilitation Sciences, Universiti Sultan Zainal Abidin, Terengganu, Malaysia
| | - FK Ooi
- Exercise and Sports Science Programme, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - MT Shihabudin
- Department of Orthopaedics, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - CK Chen
- Exercise and Sports Science Programme, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - AT Musa
- Department of Radiology, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| |
Collapse
|
22
|
Comparison of Extracorporeal Shockwave Therapy with Non-Steroid Anti-Inflammatory Drugs and Intra-Articular Hyaluronic Acid Injection for Early Osteoarthritis of the Knees. Biomedicines 2022; 10:biomedicines10020202. [PMID: 35203417 PMCID: PMC8869751 DOI: 10.3390/biomedicines10020202] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 01/10/2022] [Accepted: 01/14/2022] [Indexed: 11/17/2022] Open
Abstract
Conservative treatments for early osteoarthritis (OA) of the knee included the use of non-steroid anti-inflammatory drugs (NSAIDs) and intra-articular hyaluronic acid (HA) injection. Recently, several animal studies reported that extracorporeal shockwave therapy (ESWT) demonstrated chondroprotective effects on knee OA. The present study compared the efficacy of oral NSAIDs, HA injection, and noninvasive ESWT for early OA of the knee. Forty-five patients with early knee OA were randomized into three groups. NSAIDs group received celecoxib 200 mg daily for 3 weeks. HA group received intra-articular injection of HA once a week for 3 weeks. ESWT group received ESWT for 3 sessions at bi-weekly interval. All patients were followed up for one year. Evaluations included the visual analogue scale (VAS) score, serum enzyme-linked immunosorbent assay (ELISA), plain radiography, dual-energy X-ray absorptiometry (DEXA), and magnetic resonance imaging (MRI). In addition, the functional scores were performed including, WOMAC (Western Ontario and McMaster Universities Arthritis Index) score, KOOS (knee injury and osteoarthritis outcome) score, and IKDC (International Knee Documentation Committee) score. All three groups showed significant improvement in VAS and functional scores as well as in the collected one-year follow-up data after treatments. ESWT group had better pain relief than NSAIDs and HA groups. ESWT group had better therapeutic effects in the functional scores than NSAIDs and HA groups. The bone mineral density (BMD) of proximal tibia is significantly increased after ESWT than others. In the serum ELISA, ESWT inhibited the expression of COMP in knee OA patients as compared with NSAIDs and HA groups. The parameters of MRI showed no significant differences between three groups after treatments. ESWT and intra-articular HA injection showed comparable results than NSAIDs. ESWT was superior in pain relief than HA and NSAIDs. The results demonstrated that ESWT was an effective and alternative therapy than HA and NSAIDs for early osteoarthritis of the knees.
Collapse
|
23
|
Extracorporeal Shockwave Therapy With a Modified Technique on Tendon and Ligament for Knee Osteoarthritis: A Randomized Controlled Trial. Am J Phys Med Rehabil 2022; 101:11-17. [PMID: 34915541 DOI: 10.1097/phm.0000000000001730] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND There have been no definitive guidelines on the treatment method and specific points in the body. PURPOSE The aim of the study was to investigate the effects of extracorporeal shockwave therapy on treating the main tendons and ligaments of knee osteoarthritis. METHOD A total of 36 patients with knee osteoarthritis were enrolled in trial and organized into two groups: 3-wk extracorporeal shockwave therapy for the intervention group and 3-wk sham extracorporeal shockwave therapy for control group. Both groups received the same physical therapies: (1) transcutaneous electrical nerve stimulation, (2) magnetic field treatment, and (3) quadricep muscle strength training. Evaluation was performed before the start of treatment, at third week after the start of treatment, and 1 wk after the end of treatment. The study used randomized controlled trials (level of evidence, 1). RESULT Eextracorporeal shockwave therapy group had significant improvement in WOMAC pain score, physical function, and total score (mean difference = -2.8, P < 0.001; -5.1, P = 0.02; -8.3, P = 0.004, respectively), Visual Analog Scale score (mean difference = -2.3, P < 0.001), and the distance of 6-min walk test (mean difference = 28.7, P = 0.01) in the 1 wk after the end of treatment. Statistical significance in WOMAC pain, physical function, and total scores (mean difference = -3.0, P = 0.001; -5.6, P = 0.02; -9.3, P = 0.004, respectively) and Visual Analog Scale score (mean difference = -1.2, P = 0.027) was observed between the extracorporeal shockwave therapy group and control group. CONCLUSIONS Extracorporeal shockwave therapy for the tendons and ligaments has clinical benefits for pain and physical function improvement in knee osteoarthritis. In addition, improvement in physical performance was observed in the short-term follow-up.
Collapse
|
24
|
Coy JA, Comino-Suárez N, Grande-Muñoz J, Avendaño-López C, Gómez-Soriano J. A reply letter on "A commentary on "Extracorporeal shockwave therapy improves pain and function in subjects with knee osteoarthritis: A systematic review and meta-analysis of randomized clinical trials" [Int. J. Surg. 2020; 82:64-75]". Int J Surg 2021; 96:106177. [PMID: 34781028 DOI: 10.1016/j.ijsu.2021.106177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 11/05/2021] [Indexed: 10/19/2022]
Affiliation(s)
- Juan Avendaño- Coy
- Toledo Physiotherapy Research Group (GIFTO), Faculty of Physical Therapy and Nursing, Castilla-La Mancha University, Toledo, Spain Physiotherapy Clinic "Clifis", Ciudad Real, Spain Faculty of Physical Therapy and Nursing, Castilla-La Mancha University, Toledo, Spain
| | | | | | | | | |
Collapse
|
25
|
Computed Tomography Image Segmentation Algorithm to Detect the Curative Effect of Radial Shock Wave Therapy for Knee Osteoarthritis. JOURNAL OF HEALTHCARE ENGINEERING 2021; 2021:7098924. [PMID: 34394896 PMCID: PMC8363439 DOI: 10.1155/2021/7098924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 07/28/2021] [Indexed: 11/30/2022]
Abstract
The aim of this study was to investigate the values of computed tomography (CT) imaging technology based on image segmentation algorithm (ISA). It was applied in the radial shock wave therapy (RSWT) to treat knee osteoarthritis (KOA), so its curative effect and rehabilitation effect on nerve function were mainly analyzed in this study. 84 patients with KOA were selected and grouped into an ultrasonic treatment group (group A) and a RSW group (group B). All the patients received the ISA-based CT examination and high-quality nursing intervention. There were comparisons on the effects of pain improvement, knee joint function, and nerve function rehabilitation of patients in groups A and B. Results showed that visual analogue scale (VAS) scores before and after treatment were markedly different among all patients, and the pain degree of patients in group B was lower than the degree of group A (P < 0.05). The knee joint function of group B after treatment was greatly better than group A (P < 0.05). Scandinavian stroke scale (SSS) scores of nerve function rehabilitation after nursing in patients from group B were sharply lower than the scores of group A (P < 0.05). Results indicated that ISA-based CT images could be applied in analysis of curative effect on KOA, and there was more obvious effect of RSWT in the treatment of KOA.
Collapse
|
26
|
Whittaker JL, Truong LK, Dhiman K, Beck C. Osteoarthritis year in review 2020: rehabilitation and outcomes. Osteoarthritis Cartilage 2021; 29:190-207. [PMID: 33242604 DOI: 10.1016/j.joca.2020.10.005] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 10/05/2020] [Accepted: 10/28/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Systematically review and synthesize guidelines, systematic reviews, or randomized controlled trials (RCTs) published between April 1, 2019 and April 30, 2020 which evaluated or made recommendations for rehabilitation of persons with osteoarthritis. DESIGN Five electronic databases (Medline, EMBASE, Cochrane CENTRAL, CINHAL, Web of Science) were searched with a comprehensive search strategy. Guidelines for rehabilitation of persons with osteoarthritis, and systematic reviews and RCTs evaluating osteoarthritis rehabilitation that included at least one patient-reported outcome measure and/or clinical test of function were included. Two authors independently screened records and assessed methodological quality using the AGREE-II (guidelines), AMSTAR-2 (systematic reviews) or PEDro scale (RCTs). Data were extracted to summarize included records and a narrative synthesis of findings related to core recommended osteoarthritis rehabilitation treatments performed. RESULTS Of 2,479 potential records, 253 records were reviewed. Two guidelines, 18 systematic reviews and 38 RCTs were included. 84% (n = 49) of included records related to knee osteoarthritis, 13% (n = 8) to hip, 10% (n = 6) to hand, 3% (n = 2) to mixed, and 1% (n = 1) to foot osteoarthritis. Exercise-therapy, methods to deliver exercise-therapy remotely, and approaches to facilitate exercise-therapy behaviour change were the most commonly evaluated interventions (n = 27). 94% of systematic reviews and 63% of RCTs rated high-quality. CONCLUSIONS Osteoarthritis rehabilitation research continues to focus on knee osteoarthritis and exercise-based interventions. Emerging topics include rehabilitation of comorbid populations, exercise behaviour change and technology supports. A better understanding of rehabilitation of osteoarthritis in joints other than the knee, and methods to determine and promote ideal exercise-therapy prescription are needed.
Collapse
Affiliation(s)
- J L Whittaker
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, 2177, Wesbrook Mall, V6T 1Z3, Vancouver, Canada; Arthritis Research Canada, V6X 2C7, Richmond, Canada.
| | - L K Truong
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, 2177, Wesbrook Mall, V6T 1Z3, Vancouver, Canada; Arthritis Research Canada, V6X 2C7, Richmond, Canada
| | - K Dhiman
- Arthritis Research Canada, V6X 2C7, Richmond, Canada
| | - C Beck
- Woodward Library, University of British Columbia, Vancouver, Canada
| |
Collapse
|
27
|
Xie X, Zhu J, Zhang H. Effects of extracorporeal shock wave therapy in patients with knee osteoarthritis: A cohort study protocol. Medicine (Baltimore) 2020; 99:e21749. [PMID: 32871895 PMCID: PMC7458224 DOI: 10.1097/md.0000000000021749] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Osteoarthritis is the most common form of arthritis, and is a major cause of disability and chronic pain in adults. However, there is very limited evidence in the scientific literature to support the effectiveness of extracorporeal shockwave therapy (ESWT) in human knee osteoarthritis. This retrospective study aimed to compare the efficacy of ESWT treatment with sham-ESWT on pain, walking speed, physical function, and adverse effects in knee osteoarthritis. METHODS This study will be performed and reported in accordance with the Strengthening the Reporting of Observational studies in Epidemiology checklist. We reviewed patients diagnosed with knee osteoarthritis at our academic center from 2016 to 2017. This retrospective cohort study was approved by the institutional review board in Ruijin Hospital. The primary outcome measure was pain on movement measured by a 100-cm visual analog scale. The secondary outcome measures included the Western Ontario and McMaster University Osteoarthritis Index, range of motion, and adverse effects. Statistical analysis was performed using Statistical Package for Social Sciences version 20.0 (IBM Corporation, Armonk, NY). A P-value of <.05 was defined as statistical significance. RESULTS The hypothesis was that ESWT would be an effective treatment for improving pain and physical function in knee osteoarthritis to control symptoms. TRIAL REGISTRATION This study protocol was registered in Research Registry (researchregistry5801).
Collapse
Affiliation(s)
- Xianfei Xie
- Department of Traumatology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine
| | - Jialing Zhu
- Department of General Family Medicine, Ouyang Community Health Service Center in Hongkou District of Shanghai, Shanghai, China
| | - Hao Zhang
- Department of Traumatology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine
| |
Collapse
|
28
|
Extracorporeal shockwave therapy improves pain and function in subjects with knee osteoarthritis: A systematic review and meta-analysis of randomized clinical trials. Int J Surg 2020; 82:64-75. [PMID: 32798759 DOI: 10.1016/j.ijsu.2020.07.055] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 07/21/2020] [Accepted: 07/24/2020] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To examine the safety and effectiveness of extracorporeal shockwave therapy (ESWT) for reducing pain and improving functionality in people with knee osteoarthritis (KOA). METHODS The Cochrane Library, PubMed, CINAHL, Physiotherapy Evidence Database (PEDro) and Google Scholar were systematically searched for randomized trials published up to September 30th of 2019. The main outcome measures to evaluate the treatment effect were pain, as reported on a visual analogue scale (VAS), and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Secondary outcome measures were the range of motion (ROM) and walking tests. A quantitative analysis was conducted using the inverse variance method and the random effects model. RESULTS Fourteen studies were included (n = 782 participants and 877 knees). Moderate quality of evidence showed that ESWT causes a decrease on the pain VAS [mean difference (MD) = 1.7 cm; confidence interval (CI) 95%: 1.1-2.3] and WOMAC (MD = 13.9 points; CI 95%: 6.9-20.8). The effect of ESWT using medium energetic density was greater than with low or high density in the WOMAC (Chi2 = 9.8, p = 0.002) and bordered statistical significance on the VAS (Chi2 = 3.8, p = 0.05). Very low quality of evidence showed that ESWT causes moderate improvement in the knee ROM (MD = 17.5°; CI 95%: 9.4-25.5) and walking test [standardized mean difference (SMD) = 0.58; CI 95%: 0.35-0.81]. CONCLUSIONS ESWT is an effective treatment for improving pain and functionality in patients with KOA in the short term with few minor side effects. Further clinical trials should include longer follow-up periods and be designed to lower the risk of bias.
Collapse
|
29
|
Response to Letter Regarding “A Randomized Controlled Trial on the Effects of Low-Dose Extracorporeal Shockwave Therapy in Patients With Knee Osteoarthritis”. Arch Phys Med Rehabil 2020; 101:1266. [DOI: 10.1016/j.apmr.2020.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 03/20/2020] [Indexed: 11/23/2022]
|
30
|
Qin J, Jin T, He Z, Wu L, Lin Q, Lin Y, Zhang Y. The efficacy of extracorporeal shock wave for chronic musculoskeletal pain conditions: A protocol of systematic review and meta-analysis of randomized controlled trials. Medicine (Baltimore) 2020; 99:e19705. [PMID: 32311953 PMCID: PMC7440174 DOI: 10.1097/md.0000000000019705] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND This systematic review is the first one to assess the effectiveness and safety of extracorporeal shock-wave therapy (ESWT) for patients with chronic musculoskeletal pain conditions (CMPC). METHODS Seven electronic databases were searched for all relevant literature from inception to December 2019, including PubMed, the Web of Science, EMBASE, Cochrane library, China National Knowledge Infrastructure Database (CNKI), Chinese Scientific Journal Database (VIP), and Wanfang database. Only randomized controlled trials (RCTs) of ESWT for chronic musculoskeletal pain will be included. Two reviewers will independently select eligible studies and collected the detailed information, assessed the methodological quality. A third reviewer will join in discussion to solve disagreements. The mean difference (MD) or standard mean difference (SMD) with 95% confidence intervals (CIs) will be presented to demonstrate the effectiveness of ESWT for patients with chronic MSK pain conditions. RevMan 5.4 software will be used for statistical analysis. RESULTS This systematic review will explore the effectiveness and safety of ESWT for patients with CMPC. The primary outcome includes pain level, and secondary outcome includes function limitation and adverse events. CONCLUSION It can provide the updated evidence which is of great importance for patients, clinical practice and health related policy maker in ESWT treating CMPC.
Collapse
Affiliation(s)
- Jiawei Qin
- Department of Rehabilitation Medicine, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou
| | - Tong Jin
- Gynecological Minimally Invasive Center, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Zexiang He
- Department of Rehabilitation Medicine, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou
| | - Lijian Wu
- Department of Rehabilitation Medicine, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou
| | - Qiuxiang Lin
- Department of Rehabilitation Medicine, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou
| | - Yiheng Lin
- Department of Rehabilitation Medicine, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou
| | - Yi Zhang
- Department of Rehabilitation Medicine, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou
| |
Collapse
|
31
|
Extracorporeal Shock Wave Therapy for the Treatment of Osteoarthritis: A Systematic Review and Meta-Analysis. BIOMED RESEARCH INTERNATIONAL 2020; 2020:1907821. [PMID: 32309424 PMCID: PMC7104126 DOI: 10.1155/2020/1907821] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 02/22/2020] [Indexed: 02/05/2023]
Abstract
Background Osteoarthritis is the most common musculoskeletal disease. Extracorporeal shockwave therapy had shown an effect on osteoarthritis in both some animal experiments and clinical studies, but there was no systematic review to confirm the value of shockwave therapy in the treatment of all types of osteoarthritis and compare it with other traditional therapies (especially traditional Chinese medicine). Method PubMed, Medline, the Cochrane Central Register of Controlled Trials, Web of Science, Chinese National Knowledge Infrastructure, WANFANG database, and VIP database were searched up to December 10, 2019, to identify randomized controlled trials comparing shockwave therapy and other treatments for osteoarthritis. Visual analogue scale and the Western Ontario and McMaster Universities Osteoarthritis Index were extracted and analyzed by RevMan and STATA software as outcomes of pain reduction and functional improvement. Adverse reactions were recorded to evaluate the safety of shockwave therapy. Results Shockwave therapy had significant improvement in both pain reduction and functional improvement compared with placebo, corticosteroid, hyaluronic acid, medication, and ultrasound (P < 0.05). In functional improvement, shockwave therapy showed statistical improvement compared with kinesiotherapy and moxibustion (P < 0.05) but not with acupotomy surgery (P = 0.24). A significant difference between shockwave therapy and platelet-rich plasma was observed in pain reduction (P < 0.05) but not in functional improvement (P = 0.89). Meanwhile, a statistical difference was found between shockwave therapy and fumigation in functional improvement (P < 0.05) but not in pain reduction (P = 0.26). Additionally, there was no statistically significant difference between shockwave therapy and manipulation in both pain reduction (P = 0.21) and functional improvement (P = 0.45). No serious adverse reaction occurred in all of studies. Conclusions Extracorporeal shockwave therapy could be recommended in the treatment of osteoarthritis as a noninvasive therapy with safety and effectiveness, but the grade of recommendations needs to be discussed in a further study.
Collapse
|
32
|
Zheng S, Wang Y. Commentary on "The efficacy and safety of extracorporeal shockwave therapy in knee osteoarthritis: A systematic review and meta-analysis" (Int J Surg. 2020 Jan 21; 75: 24-34). Int J Surg 2020; 76:27. [PMID: 32084543 DOI: 10.1016/j.ijsu.2020.02.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 02/10/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Sensen Zheng
- Department of Hand and Foot Orthopedic Surgery, Weifang People's Hospital, Shandong, PR China
| | - Yanyan Wang
- Department of Hand and Foot Orthopedic Surgery, Weifang People's Hospital, Shandong, PR China.
| |
Collapse
|
33
|
Su W, Lin Y, Wang G, Geng Z, Wang Z, Hou D, Suo B. [Prospective clinical study on extracorporeal shock wave therapy combined with platelet-rich plasma injection for knee osteoarthritis]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2019; 33:1527-1531. [PMID: 31823552 PMCID: PMC8355794 DOI: 10.7507/1002-1892.201905007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Revised: 09/19/2019] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To investigate the effectiveness of extracorporeal shock wave therapy combined with platelet-rich plasma (PRP) injection in treatment of knee osteoarthritis (KOA) by prospective clinical study. METHODS Between June 2015 and June 2018, 180 patients with KOA met the inclusion criteria were included in study and randomly allocated to group A (n=60), group B (n=60), and group C (n=60). The patients were treated with autologous PRP intra-articular injection in group A, extracorporeal shock wave therapy in group B, and extracorporeal shock wave therapy combined with autologous PRP intra-articular injection in group C, once a week and 5 times a duration of treatment. There was no significant difference in age, gender, disease duration, side of KOA, and Kellgren-Lawrence grading between groups (P>0.05). The pain and function of knee joint were assessed by visual analogue scale (VAS) score, Lequesne Index score, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, and knee joint activity before treatment and at 1, 3, and 5 weeks after the first treatment. RESULTS There were significant differences in VAS score, Lequesne Index score, WOMAC score, and knee joint activity between pre- and post-treatment in all groups (P<0.05). VAS score, Lequesne Index score, and WOMAC score gradually decreased with the prolongation of treatment time (P<0.05); but there was no significant difference in knee joint activity between different time points (P>0.05). There was no significant difference in VAS score, Lequesne Index score, WOMAC score, and knee joint activity between groups before treatment (P>0.05); the scores of group C were superior to groups A and B (P< 0.05) at different time points after treatment; while the knee joint activities of 3 groups were similar (P>0.05). CONCLUSION The extracorporeal shock wave therapy combined with PRP injection can relieve the pain synergistically for KOA.
Collapse
Affiliation(s)
- Wenzhen Su
- Department of Orthopaedics, the Shandong Provincial Third Hospital, Jinan Shandong, 250031, P.R.China
| | - Yongjie Lin
- Department of Orthopaedics, the Shandong Provincial Third Hospital, Jinan Shandong, 250031,
| | - Guowei Wang
- Department of Orthopaedics, the Shandong Provincial Third Hospital, Jinan Shandong, 250031, P.R.China
| | - Zhen Geng
- Department of Orthopaedics, the Shandong Provincial Third Hospital, Jinan Shandong, 250031, P.R.China
| | - Zhengyu Wang
- Department of Orthopaedics, the Shandong Provincial Third Hospital, Jinan Shandong, 250031, P.R.China
| | - Dalong Hou
- Department of Orthopaedics, the Shandong Provincial Third Hospital, Jinan Shandong, 250031, P.R.China
| | - Beibei Suo
- Department of Orthopaedics, the Shandong Provincial Third Hospital, Jinan Shandong, 250031, P.R.China
| |
Collapse
|