Efficacy and safety of extracorporeal shockwave therapy in chronic low back pain: a systematic review and meta-analysis of 632 patients

Physiotherapeutic and non-conventional approaches in patients with chronic low-back pain: a level I Bayesian network meta-analysis

Chronic low back pain (cLBP) is a major cause of disability and healthcare expenditure worldwide. Its prevalence is increasing globally from somatic and psychosocial factors. While non-pharmacological management, and in particular physiotherapy, has been recommended as a first-line treatment for cLBP, it is not clear what type of physiotherapeutic approach is the most effective in terms of pain reduction and function improvement. This analysis is rendered more difficult by the vast number of available therapies and a lack of a widely accepted classification that can effectively highlight the differences in the outcomes of different management options. This study was conducted according to the PRISMA guidelines. In January 2024, the following databases were accessed: PubMed, Web of Science, Google Scholar, and Embase. All the randomised controlled trials (RCTs) which compared the efficacy of physiotherapy programs in patients with cLBP were accessed. Studies reporting on non-specific or mechanical cLPB were included. Data concerning the Visual Analogic Scale (VAS) or numeric rating scale (NRS), Roland Morris Disability Questionnaire (RMQ) and Oswestry Disability Index (ODI). Data from 12,773 patients were collected. The mean symptom duration was 61.2 ± 51.0 months and the mean follow-up was 4.3 ± 5.9 months. The mean age was 44.5 ± 9.4 years. The mean BMI was 25.8 ± 2.9 kg/m2. The Adapted Physical Exercise group evidenced the lowest pain score, followed by Multidisciplinary and Adapted Training Exercise/Complementary Medicine. The Adapted Physical Exercise group evidenced the lowest RMQ score followed by Therapeutic Exercises and Multidisciplinary. The Multidisciplinary group evidenced the lowest ODI score, followed by Adapted Physical Exercise and Physical Agent modalities. Within the considered physiotherapeutic and non-conventional approaches to manage nonspecific and/or mechanic cLBP, adapted physical exercise, physical agent modalities, and a multidisciplinary approach might represent the most effective strategy to reduce pain and disability.

The effect of extracorporeal shock-wave therapy on pain in patients with various tendinopathies: a systematic review and meta-analysis of randomized control trials

OBJECTIVES

Tendinopathy is a common condition that affects the body's tendon structures, causing discomfort, restricted movement, and reduced functionality. In this study, we looked at how extracorporeal shock wave therapy (ESWT) affected pain levels in individuals with various forms of tendinopathy around the world.

DESIGN

This study is a comprehensive review and meta-analysis of previously published randomized controlled trials. To gather relevant data, the researchers performed keyword searches in international databases, including PubMed (Medline), Scopus, Web of Sciences, Cochrane Central Register of Controlled Trials (CENTRAL), Research Registers of ongoing trials (ClinicalTrials.gov), as well as Embase. The search was conducted up until March 2023. The quality of the selected articles was assessed using the Cochrane risk-of-bias method for randomized trials (RoB2).

RESULTS

Based on the results of the meta-analysis, which included 45 clinical studies, the use of ESWT was found to have a significant impact on reducing pain in various conditions. The standardized mean difference (SMD) in patients with plantar fasciitis (PF) was reduced by 1.63 (SMD: -1.63, 95% CI: -3.04, -0.21; I2: 77.36%; P heterogeneity: 0.0001). For lateral epicondylitis (LE), the SMD was 0.63 (SMD: -0.63, 95% CI: -1.11, -0.16; I2: 67.50%; P heterogeneity: 0.003). In the case of chronic Achilles tendinopathy, the SMD was 1.38 (SMD: -1.38, 95% CI: -1.66, -1.10; I2: 96.44%; P heterogeneity: 0.0001). Additionally, in individuals with rotator cuff tendinopathy, the SMD for pain reduction was 2.37 units (SMD: -2.37, 95% CI: -3.58, -1.15; I2: 98.46%; P heterogeneity: 0.0001).

CONCLUSION

This study suggests that ESWT can be a highly effective therapy option for relieving pain in people with tendinopathy. Nonetheless, it is encouraged to make additional recommendations based on high-quality clinical research and more accurate information in order to define the optimal therapeutic options for each type of tendinopathy.

Extracorporeal shock wave therapy for low back pain: A systematic review and meta-analysis

BACKGROUND

To provide high-quality evidence for extracorporeal shock wave therapy (ESWT) for low back pain (LBP).

METHODS

A computerized search screened trials of ESWT for LBP, and the time range was from the establishment of databases to August 2023, including CNKI, CBMdisc, Wanfang Data, VIP, PubMed, Web of Science, Embase, and Cochrane databases. The outcomes were extracted, including patients' pain, physical and psychological conditions, and adverse reactions. Meta-analysis was completed using Revman 5.4 and Stata 15 software, and GRADEpro software quantitated rate the evidence and assigned a recommendation strength.

RESULTS

This meta-analysis included 22 studies involving 1749 patients. After treatment, patients in the ESWT group had lower scores in the visual analog scale (VAS) (mean difference [MD] = -1.14, 95% confidence interval [CI] (-1.47, -0.80), P < .00001), Oswestry disability index (ODI) [MD = -6.01, 95%CI (-7.97, -4.05), P < .00001], and Beck depression inventory [MD = -3.89, 95%CI (-6.59, -1.20), P = .005]; finger-floor distance [MD = -3.71, 95%CI (-5.26, -2.17), P < .00001] was shorter; Japanese orthopedic association scores [MD = 3.20, 95%CI (1.56, 4.85), P = .0001] were higher; at the 3-month follow-up, the VAS [MD = -1.29, 95%CI (-2.39, -0.19), P = .02] and ODI [MD = -5.95, 95%CI (-10.06, -1.84), P = .005] remained lower; adverse reactions [odds ratio = 0.19, 95%CI (0.07, 0.52), P = .001] were less, and the valid cases [odds ratio = 3.84, 95%CI (2.47, 5.96), P < .00001] were more. Sensitivity analyses revealed that the results were stable; Egger test found no publication bias in VAS (P = .270) and valid cases (P = .747); the trim and fill analysis tested the robustness of ODI scores due to the publication bias (P = .029), and the effect sizes before and after the trim and fill were consistent, which means the result was robust.

CONCLUSION

ESWT for LBP has efficacy and safety in improving pain, dysfunction, and psychological conditions compared to other therapies. ESWT has shown advantages in terms of long-term efficacy. Randomized controlled trials with larger sample sizes and more objective outcomes are required.