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Ferdinandov D. Focused extracorporeal shockwave therapy for the treatment of low back pain: a systematic review. Front Med (Lausanne) 2024; 11:1435504. [PMID: 39267973 PMCID: PMC11390445 DOI: 10.3389/fmed.2024.1435504] [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: 05/20/2024] [Accepted: 08/16/2024] [Indexed: 09/15/2024] Open
Abstract
Introduction Low back pain (LBP) is a common condition affecting up to 84% of people in their lifetime, with a prevalence of 11.9% and a high recurrence rate within the first year. Furthermore, chronic low back pain syndrome has been described in up to 7%, making it a significant health and socioeconomic problem. Among nonoperative treatment options, the recently used focused extracorporeal shockwave therapy (ESWT) devices generate waves that converge at a precise depth in the body, thereby revealing the potential to affect pathology remotely from the contact surface. The article aims to present a systematic literature review with a critical discussion on treating low back pain using this modality. Methods A search for randomized controlled trials (RCT) of focused ESWT for low back pain published before April 1, 2024, in PubMed, Web of Science, Scopus, Google Scholar, and trial registries (WHO International Clinical Trials Registry Platform and ClinicaTrials.gov) was performed. Results Only three studies against conservative treatment comprising 94 patients met the selection criteria and were further analyzed. Comparative clinical studies regarding the effectiveness of radial and focused ESWT for low back pain were missing. The results revealed that all treated patients had significantly reduced pain and improved functional impairment immediately after the procedures and 1 month later. At the third month time point, the pain levels remained better in the experimental than in the control group without achieving statistical significance. None of the studies had a long-term follow-up. Conclusion Focused ESWT is a modern physiotherapeutic method that can potentially treat a broad spectrum of conditions responsible for low back pain. Despite the small number of low-evidence studies, there is sufficient data on the effectiveness and safety of this therapeutic modality. With future well-designed trials, the bias risks would be diminished, the indications for its use would expand, and the treatment protocols would be clarified.
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Affiliation(s)
- Dilyan Ferdinandov
- Department of Neurosurgery, Faculty of Medicine, Medical University - Sofia, Sofia, Bulgaria
- Clinic of Neurosurgery, St. Ivan Rilski University Hospital, Sofia, Bulgaria
- Vertebra Medical Center, Sofia, Bulgaria
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Liu K, Zhang Q, Chen L, Zhang H, Xu X, Yuan Z, Dong J. Efficacy and safety of extracorporeal shockwave therapy in chronic low back pain: a systematic review and meta-analysis of 632 patients. J Orthop Surg Res 2023; 18:455. [PMID: 37355623 DOI: 10.1186/s13018-023-03943-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 06/19/2023] [Indexed: 06/26/2023] Open
Abstract
BACKGROUND Extracorporeal shock wave therapy (ESWT) has been widely used for pain control in musculoskeletal disorders. Whether ESWT can relieve chronic low back pain (CLBP) and improve lumbar function is still unclear. Therefore, we conducted a meta-analysis of relevant studies to comprehensively analyse and determine the efficacy and safety of ESWT for chronic low back pain. METHODS Four databases were systematically searched for randomized controlled trials (RCTs) on ESWT for CLBP. The quality of the included studies was evaluated according to Cochrane systematic review criteria, relevant data were extracted, and meta-analysis was performed using RevMan 5.4 software. The primary outcomes were pain intensity, disability status, and mental health. The data were expressed as standardized mean differences (SMD) or weighted mean difference (WMD) and 95% confidence intervals (CI). Heterogeneity was assessed using the I2 statistic. If I2 ≥ 50%, a random effects model was applied; otherwise, a fixed effects model was used. RESULTS Twelve RCTs involving 632 patients were included in this meta-analysis. The ESWT group reported significantly more pain relief than the control group at 4 weeks (WMD = - 1.04; 95% CI = - 1.44 to - 0.65; P < 0.001) and 12 weeks (WMD = - 0.85; 95% CI = - 1.30 to - 0.41; P < 0.001). Regarding the dysfunction index, ESWT led to significant improvement in lumbar dysfunction compared with the control group at 4 weeks (WMD = - 4.22; 95% CI = - 7.55 to - 0.89; P < 0.001) and 12 weeks (WMD = - 4.51; 95% CI = - 8.58 to - 0.44; P = 0.03). For mental health, there was no significant difference between the ESWT group and the control group after 4 weeks of intervention (SMD = 1.17; 95% CI = - 0.10 to 2.45; P = 0.07). CONCLUSION This systematic review and meta-analysis found that ESWT provided better pain relief and improved lumbar dysfunction compared with the other interventions included, and no serious adverse effects were found. There was no significant effect of ESWT on the mental health of patients, but we hope to obtain more RCTs for further analysis in the future. Based on the pooled results, we suggest that ESWT is effective and safe for treating chronic low back pain.
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Affiliation(s)
- Kun Liu
- Shandong Sport University, No.10600, Road Century, Jinan, 250102, Shandong, China
| | - Qingyu Zhang
- Department of Orthopedics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No.324, Road Jing Wu Wei Qi, Jinan, 250021, Shandong, China
| | - Lili Chen
- Shandong Sport University, No.10600, Road Century, Jinan, 250102, Shandong, China
| | - Haoran Zhang
- Department of Orthopedics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No.324, Road Jing Wu Wei Qi, Jinan, 250021, Shandong, China
| | - Xiqiang Xu
- Department of Orthopedics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No.324, Road Jing Wu Wei Qi, Jinan, 250021, Shandong, China
| | - Zenong Yuan
- Department of Orthopedics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No.324, Road Jing Wu Wei Qi, Jinan, 250021, Shandong, China
| | - Jun Dong
- Department of Orthopedics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No.324, Road Jing Wu Wei Qi, Jinan, 250021, Shandong, China.
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Li C, Xiao Z, Chen L, Pan S. Efficacy and safety of extracorporeal shock wave on low back pain: A systematic review and meta-analysis. Medicine (Baltimore) 2022; 101:e32053. [PMID: 36595991 PMCID: PMC9803516 DOI: 10.1097/md.0000000000032053] [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: 12/31/2022] Open
Abstract
BACKGROUND Extracorporeal shock wave therapy (ESWT) is a relatively new type of treatment for many musculoskeletal disorders. However, ESWT for low back pain remains controversial as the pain relieve benefit is questionable. We performed this systematic review and meta-analysis to explore the effectiveness and safety of ESWT interventions on pain and disability in patients with low back pain (LBP). METHODS In this meta-analysis, we searched electronic databases in the Pubmed, Embase, Cochrane's library, China National Knowledge Infrastructure, and Wanfang Database to determine the equivalence of ESWT and placebo for the treatment of LBP up to April 4, 2022. A number of other outcomes were measured, including functional status, quality of life, and psychological outcomes measured by the Oswestry Disability Index. Weighted mean differences were calculated for continuous outcomes, while risk ratios were calculated for binary outcomes. Stata 12.0 software was used for statistical analysis. RESULTS Thirteen randomized controlled trials included for further analysis. Compared with control, the ESWT group showed lower pain intensity at month 1 (P < .05), as well as lower disability score at month 1 (P < .05) and at month 3 (P < .05). There was no statistically significant difference between ESWT and control groups in terms of the pain intensity at month 3 (P > .05). No serious adverse events related to treatment were reported. Sensitivity analysis demonstrates that the conclusions from this analysis were robust. CONCLUSIONS ESWT is effective in alleviating pain and improving the functional outcomes for patients with LBP. However, there remains a lack of high-level evidence to verify their effectiveness and safety and support their clinical application.
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Affiliation(s)
- Chunhong Li
- Department of Operating Room, The First Affiliated Hospital of Hainan Medical University, Hainan, China
| | - Zhibo Xiao
- Department of Anesthesiology, The First Affiliated Hospital of Hainan Medical University, Hainan, China
| | - Liuli Chen
- Department of Operating Room, The First Affiliated Hospital of Hainan Medical University, Hainan, China
| | - Songli Pan
- Department of Operating Room, The First Affiliated Hospital of Hainan Medical University, Hainan, China
- Department of Spine Surgery, The First Affiliated Hospital of Hainan Medical University, Hainan, China
- *Correspondence: Songli Pan, Department of Spine Surgery, The First Affiliated Hospital of Hainan Medical University, No. 3, Longhua Road, Longhua district, Haikou, Hainan Province, 570102, PR China (e-mail: )
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Yue L, Sun MS, Chen H, Mu GZ, Sun HL. Extracorporeal Shockwave Therapy for Treating Chronic Low Back Pain: A Systematic Review and Meta-analysis of Randomized Controlled Trials. BIOMED RESEARCH INTERNATIONAL 2021; 2021:5937250. [PMID: 34840977 PMCID: PMC8617566 DOI: 10.1155/2021/5937250] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 10/19/2021] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To assess the effectiveness and safety of extracorporeal shockwave therapy (ESWT) for the treatment of chronic low back pain (CLBP). METHODS This was a systematic review and meta-analysis of randomized controlled trials (RCTs) designed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analysis statement standard. We identified relevant studies by searching multiple electronic databases, trial registries, and websites up to April 30, 2021, and examining reference lists. We selected RCTs that compared ESWT, in unimodal or multimodal therapeutic approaches, with sham ESWT or other active therapies. Two investigators independently extracted data and assessed the risk of bias and quality of the evidence. The main outcomes were pain intensity and disability status, examined as standardized mean differences (SMD) with 95% confidence intervals (CI). The risk of bias was assessed by using Cochrane Back and Neck (CBN) Group risk of bias tool and Jadad score, and GRADE was applied to determine the confidence in effect estimates. Heterogeneity was explored using sensitivity analysis and meta-regression. RESULTS Ten RCTs, including a total of 455 young to middle-aged individuals (29.2-55.8 years), were identified. Compared with control, the ESWT group showed lower pain intensity at month 1 (SMD = -0.81, 95% CI -1.21 to -0.42), as well as lower disability score at month 1 (SMD = -1.45, 95% CI -2.68 to -0.22) and at month 3 (SMD = -0.69, 95% CI -1.08 to -0.31). No serious shockwave-related adverse events were reported. CONCLUSION The use of ESWT in CLBP patients results in significant and quantifiable reductions in pain and disability in the short term. However, further well-conducted RCTs are necessary for building high-quality evidence and promoting the application of ESWT in clinical practice.
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Affiliation(s)
- Lei Yue
- Department of Orthopaedics, Peking University First Hospital, Beijing 100034, China
| | - Ming-shuai Sun
- Department of General Surgery, Peking University First Hospital, Beijing 100034, China
| | - Hao Chen
- Department of Rehabilitation, Peking University First Hospital, Beijing 100034, China
| | - Guan-zhang Mu
- Department of Orthopaedics, Peking University First Hospital, Beijing 100034, China
| | - Hao-lin Sun
- Department of Orthopaedics, Peking University First Hospital, Beijing 100034, China
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Taheri P, Khosrawi S, Ramezani M. Extracorporeal Shock Wave Therapy Combined With Oral Medication and Exercise for Chronic Low Back Pain: A Randomized Controlled Trial. Arch Phys Med Rehabil 2021; 102:1294-1299. [PMID: 33453192 DOI: 10.1016/j.apmr.2020.12.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 12/10/2020] [Accepted: 12/11/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To compare extracorporeal shock wave therapy combined with oral medication and an exercise program vs sham treatment with medication and exercise for the treatment of chronic low back pain (CLBP). DESIGN Randomized controlled trial. SETTING Outpatient clinic at a university hospital. PARTICIPANTS Eligibility criteria were age older than 18 years and duration of CLBP exceeding 3 months. Exclusion criteria were concurrent treatment or history of surgery for CLBP, cancer, fractures, infections, and disk degeneration. INTERVENTION The intervention group received extracorporeal shock wave therapy once a week for 4 weeks along with oral medications and an exercise program. The control group received sham extracorporeal shock wave therapy along with oral medications and an exercise program. MAIN OUTCOME MEASURES Visual analog scale and Oswestry Disability Index (ODI) were used to assess pain and disability at baseline and after 3 months. RESULTS The pain score in the intervention group (N=16) was 6.6 at baseline and 3.0 after 1 month (P<.0001) and 1.8 after 3 months (P<.0001). In the control group (N=16), the pain score was 6.8 at baseline, 4.6 after 1 month (P<.0001), and 1.1 after 3 months (P<.0001). ODI scores decreased significantly in both groups compared with baseline values (first month: P<.001, third month: P<.05). The mean ODI score did not differ significantly between the groups (P=.942). CONCLUSION Extracorporeal shock wave therapy combined with oral medication and exercise was safe and effective in the short-term treatment of chronic low back pain.
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Affiliation(s)
- Parisa Taheri
- Department of Physical Medicine and Rehabilitation, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Saeed Khosrawi
- Department of Physical Medicine and Rehabilitation, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mitra Ramezani
- Department of Physical Medicine and Rehabilitation, Isfahan University of Medical Sciences, Isfahan, Iran.
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Li L, Stoop R, Clijsen R, Hohenauer E, Fernández-de-Las-Peñas C, Huang Q, Barbero M. Criteria Used for the Diagnosis of Myofascial Trigger Points in Clinical Trials on Physical Therapy: Updated Systematic Review. Clin J Pain 2020; 36:955-967. [PMID: 32841969 DOI: 10.1097/ajp.0000000000000875] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The objective of this study was to conduct an updated systematic review of diagnostic criteria for myofascial trigger points (MTrPs) used in clinical trials of physical therapy interventions from 2007 to 2019. METHODS MEDLINE and Physiotherapy Evidence Database (PEDro) were searched using the following MeSH keywords: "trigger points," "trigger point," "myofascial trigger point," "myofascial trigger points," "myofascial pain," and "myofascial pain syndrome." The MeSH keywords were combined by using Boolean operators "OR"/"AND." All physiotherapy clinical trials including patients with musculoskeletal conditions characterized by at least 1 active MTrP or latent MTrP in any body area were selected. We pooled data from an individual criterion and criteria combinations used to diagnose MTrPs. The protocol was developed in accordance with the PRISMA-P guidelines. RESULTS Of 478 possibly relevant publications, 198 met the inclusion criteria. Of these 198 studies, 129 studies (65.1%) stated specifically the diagnostic criteria used for MTrPs in the main text, 56 studies (28.3%) failed to report any method whereby MTrP was diagnosed, and 13 studies (6.6%) adopted expert-based definitions for MTrPs without specification. Of 129 studies, the 6 criteria applied most commonly were: "spot tenderness" (n=125, 96.9%), "referred pain" (95, 73.6%), "local twitch response" (63, 48.8%), pain recognition (59, 45.7%), limited range of motion" (29, 22.5%), and "jump sign" (10, 7.8%). Twenty-three combinations of diagnostic criteria were identified. The most frequently used combination was "spot tenderness," "referred pain," and "local twitch response" (n=28 studies, 22%). CONCLUSIONS A number of the included studies failed in properly reporting the MTrP diagnostic criteria. Moreover, high variability in the use of MTrP diagnostic was also observed. Spot tenderness, referred pain, and local twitch response were the 3 most popular criteria (and the most frequently used combination). A lack of transparency in the reporting of MTrP diagnostic criteria is present in the literature. REGISTRY This systematic review was registered under the Centre for Reviews and Dissemination, PROSPERO number: CRD42018087420.
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Affiliation(s)
- Lihui Li
- Rehabilitation Research Laboratory 2rLab, Department of Business Economics Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Manno
- School of Medicine, Southern University of Science and Technology, Shenzhen
- Department of Sport Medicine and Rehabilitation Center, Shanghai University of Sport, Shanghai, China
| | - Rahel Stoop
- Rehabilitation Research Laboratory 2rLab, Department of Business Economics Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Manno
- International University of Applied Sciences THIM, Landquart, Switzerland
| | - Ron Clijsen
- Rehabilitation Research Laboratory 2rLab, Department of Business Economics Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Manno
- International University of Applied Sciences THIM, Landquart, Switzerland
- Department of Movement and Sport Sciences, Vrije Universiteit Brussel, Brussels, Belgium
| | - Erich Hohenauer
- Rehabilitation Research Laboratory 2rLab, Department of Business Economics Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Manno
- International University of Applied Sciences THIM, Landquart, Switzerland
- Department of Movement and Sport Sciences, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Sport and Exercise Science, University of Portsmouth, Portsmouth, UK
| | - César Fernández-de-Las-Peñas
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation
- Cátedra Institucional en Docencia, Clínica e Investigación en Fisioterapia: Terapia Manual, Punción Seca y Ejercicio Terapéutico, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
| | - Qiangmin Huang
- Department of Sport Medicine and Rehabilitation Center, Shanghai University of Sport, Shanghai, China
| | - Marco Barbero
- Rehabilitation Research Laboratory 2rLab, Department of Business Economics Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Manno
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Walewicz K, Taradaj J, Rajfur K, Ptaszkowski K, Kuszewski MT, Sopel M, Dymarek R. The Effectiveness Of Radial Extracorporeal Shock Wave Therapy In Patients With Chronic Low Back Pain: A Prospective, Randomized, Single-Blinded Pilot Study. Clin Interv Aging 2019; 14:1859-1869. [PMID: 31806944 PMCID: PMC6857735 DOI: 10.2147/cia.s224001] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Accepted: 09/26/2019] [Indexed: 12/13/2022] Open
Abstract
Purpose This prospective, randomized and single-blinded study assesses the influence of radial extracorporeal shock wave therapy (rESWT) in patients with low back pain (LBP). Methods A total of 52 patients with LBP were enrolled in the study, out of which a homogeneous group of 40 patients with mean age of 53.45±4.9 years was included. Patients were randomized into group A (n=20) treated with rESWT (2000 pulses; 2.5 bars; 5 Hz, 7 mins) performed twice a week for five weeks (10 sessions) and stabilization training, as well as group B (n=20) treated with sham rESWT and stabilization training. To analyze the therapeutic progress, the following tests were performed (before and after therapy; 1 and 3 months follow-up) to assess pain and functional efficiency: (1) Visual Analog Scale (VAS), (2) Laitinen Pain Scale (LPS), and (3) Oswestry Disability Index (ODI). Results The control group had a statistically significant advantage over the rESWT group (4.4 vs. 3.1 points on the VAS; p=0.039). However, in long-term observations, group A gradually experienced more pain relief than group B (2.7 vs. 3.5 points, p>0.05, at one month and 2.0 vs. 4.4 points at three months after treatment; p<0.0001). Similar findings can be seen in the analysis of changes in pain sensations measured with the LPS. The functional state (ODI) was better in rESWT group, especially in follow-up observation (9.3 vs. 14.6 points, p=0.033, at one month and 9.3 vs. 17.8 points, p=0.004, at three months after treatment). Conclusion The rESWT combined with stabilization training is particularly effective in the long-term and achieves a stable beneficial effect for patients with LBP. The use of rESWT has a significant long-term influence on the reduction of pain and the improvement of the general functional state in relation to the conventional motor improvement program.
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Affiliation(s)
| | - Jakub Taradaj
- Institute of Physiotherapy and Health Sciences, Academy of Physical Education, Katowice, Poland.,College of Rehabilitation Sciences, University of Manitoba, Winnipeg, MB, Canada
| | | | - Kuba Ptaszkowski
- Department of Physiotherapy, Wroclaw Medical University, Wroclaw, Poland
| | - Michał Tomasz Kuszewski
- Institute of Physiotherapy and Health Sciences, Academy of Physical Education, Katowice, Poland
| | - Mirosław Sopel
- Department of Nervous System Diseases, Wroclaw Medical University, Wroclaw, Poland
| | - Robert Dymarek
- Department of Nervous System Diseases, Wroclaw Medical University, Wroclaw, Poland
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Schneider R. Low-frequency vibrotherapy considerably improves the effectiveness of manual lymphatic drainage (MLD) in patients with lipedema: A two-armed, randomized, controlled pragmatic trial. Physiother Theory Pract 2018; 36:63-70. [DOI: 10.1080/09593985.2018.1479474] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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