Al-Abbad Hani, Allen Sophie, Morris Susan, Reznik Jackie, Biros Erik, Paulik Bruce, Wright Anthony
School of Physiotherapy and Exercise Science, Curtin University, GPO Box U1987, Perth, WA, Australia.
Physical Therapy department, Rehabilitation hospital, King Fahad Medical City, Riyadh, Saudi Arabia.
BMC Musculoskelet Disord. 2020 Apr 28;21(1):275. doi: 10.1186/s12891-020-03270-w.
Shockwave therapy (SWT) is a commonly used intervention for a number of musculoskeletal conditions with varying clinical outcomes. However, the capacity of SWT to influence pathophysiological processes and the morphology of affected tissues remains unclear. The objective of the current review is to evaluate changes in imaging outcomes of musculoskeletal conditions following SWT.
A comprehensive search of Medline, Embase, Cochrane Controlled Trials Register, CINAHL and SportDiscus was conducted from inception to October 2018. Prospective clinical trials evaluating the effectiveness of SWT based on changes in imaging outcomes were eligible for inclusion. Articles were evaluated independently for risk of bias using the Cochrane Risk of Bias list and the Methodological Index for Non-Randomized Studies. Random-effects meta-analysis and meta-regression with a priori determined covariates was conducted for each condition to determine potential predictors of SWT effects.
Sixty-three studies were included, with data from 27 studies available for effect size pooling. Meta-analyses and meta-regression on imaging outcomes were performed for rotator cuff calcific tendinitis (n = 11), plantar fasciitis (n = 7) and osteonecrosis of the femoral head (n = 9). There was an overall reduction in the size of measured lesion following SWT (MD 8.44 mm (95%CI -4.30, 12.57), p < 0.001) for calcium deposit diameter, (MD 0.92 mm (95%CI -0.03, 1.81), p = 0.04) for plantar fascia thickness and (MD 4.84% (95%CI -0.06, 9.75), p = 0.05) for lesion size in femoral head osteonecrosis. Meta-regression showed no influence of SWT dosage parameters, however, baseline lesion size was an independent predictor for changes in imaging outcomes.
SWT altered the morphology of musculoskeletal conditions, potentially reflecting changes in underlying pathophysiological processes. The parameters of SWT dosage are not significant predictors of changes in imaging outcomes. Lack of adequate reporting of imaging outcomes limited the conclusions that could be drawn from the current review. Registration number: PROSPERO CRD42018091140.
冲击波疗法（SWT）是针对多种肌肉骨骼疾病常用的一种干预措施，临床疗效各异。然而，SWT对病理生理过程及受累组织形态的影响尚不明确。本综述的目的是评估SWT治疗后肌肉骨骼疾病影像学结果的变化。
对Medline、Embase、Cochrane对照试验注册库、CINAHL和SportDiscus进行全面检索，检索时间从建库至2018年10月。基于影像学结果变化评估SWT疗效的前瞻性临床试验符合纳入标准。使用Cochrane偏倚风险列表和非随机研究方法学指数对文章的偏倚风险进行独立评估。针对每种疾病进行随机效应荟萃分析和具有先验确定协变量的荟萃回归分析，以确定SWT疗效的潜在预测因素。
纳入63项研究，其中27项研究的数据可用于效应量合并。对肩袖钙化性肌腱炎（n = 11）、足底筋膜炎（n = 7）和股骨头坏死（n = 9）进行了影像学结果的荟萃分析和荟萃回归分析。SWT治疗后，钙沉积直径的测量病变大小总体减小（MD 8.44 mm（95%CI -4.30，12.57），p < 0.001），足底筋膜厚度减小（MD 0.92 mm（95%CI -0.03，1.81），p = 0.04），股骨头坏死的病变大小减小（MD 4.84%（95%CI -0.06，9.75），p = 0.05）。荟萃回归分析显示SWT剂量参数无影响，然而，基线病变大小是影像学结果变化的独立预测因素。
SWT改变了肌肉骨骼疾病的形态，可能反映了潜在病理生理过程的变化。SWT剂量参数不是影像学结果变化的显著预测因素。影像学结果报告不充分限制了本综述得出的结论。注册号：PROSPERO CRD42018091140。
