Paantjens Marc A, Helmhout Pieter H, Backx Frank J G, van Etten-Jamaludin Faridi S, Bakker Eric W P
Sports Medicine Centre, Training Medicine and Training Physiology, Royal Netherlands Army, Utrecht, The Netherlands.
Department of Rehabilitation, Physical Therapy Science and Sports, University Medical Center Utrecht, Utrecht, The Netherlands.
Sports Med Open. 2022 May 13;8(1):68. doi: 10.1186/s40798-022-00456-5.
Extracorporeal shockwave therapy (ESWT) is used commonly to treat pain and function in Achilles tendinopathy (AT). The aim of this study was to synthesize the evidence from (non-) randomized controlled trials, to determine the clinical effectiveness of ESWT for mid-portion Achilles tendinopathy (mid-AT) and insertional Achilles tendinopathy (ins-AT) separately.
We searched PubMed/Medline, Embase (Ovid), and Cochrane Central, up to January 2021. Unpublished studies and gray literature were searched in trial registers (ACTRN, ChiCTR, ChiCtr, CTRI, DRKS, EUCTR, IRCT, ISRCTN, JPRN UMIN, ClinicalTrials.gov, NTR, TCTR) and databases (OpenGrey.eu, NARCIS.nl, DART-Europe.org, OATD.org). Randomized controlled trials (RCTs) and non-randomized controlled clinical trials (CCTs) were eligible when investigating the clinical effectiveness of ESWT for chronic mid-AT or chronic ins-AT. We excluded studies that focused on treating individuals with systemic conditions, and studies investigating mixed cohorts of mid-AT and ins-AT, when it was not possible to perform a subgroup analysis for both clinical entities separately. Two reviewers independently performed the study selection, quality assessment, data extraction, and grading of the evidence levels. Discrepancies were resolved through discussion or by consulting a third reviewer when necessary.
We included three RCTs on mid-AT and four RCTs on ins-AT. For mid-AT, moderate quality of evidence was found for the overall effectiveness of ESWT compared to standard care, with a pooled mean difference (MD) on the VISA-A of 9.08 points (95% CI 6.35-11.81). Subgroup analysis on the effects of ESWT additional to standard care for mid-AT resulted in a pooled MD on the VISA-A of 10.28 points (95% CI 7.43-13.12). For ins-AT, we found very low quality of evidence, indicating that, overall, ESWT has no additional value over standard care, with a standardized mean difference (SMD) of - 0.02 (95% CI - 0.27 to 0.23). Subgroup analysis to determine the effect of ESWT additional to standard care for ins-AT showed a negative effect (SMD - 0.29; 95% CI - 0.56 to - 0.01) compared to standard care alone.
There is moderate evidence supporting the effectiveness of ESWT additional to a tendon loading program in mid-AT. Evidence supporting the effectiveness of ESWT for ins-AT is lacking.
PROSPERO Database; No. CRD42021236107.
体外冲击波疗法（ESWT）常用于治疗跟腱病（AT）的疼痛和功能问题。本研究的目的是综合（非）随机对照试验的证据，分别确定ESWT治疗中部跟腱病（mid-AT）和附着点性跟腱病（ins-AT）的临床疗效。
我们检索了截至2021年1月的PubMed/Medline、Embase（Ovid）和Cochrane Central。在试验注册库（ACTRN、ChiCTR、ChiCtr、CTRI、DRKS、EUCTR、IRCT、ISRCTN、JPRN UMIN、ClinicalTrials.gov、NTR、TCTR）和数据库（OpenGrey.eu、NARCIS.nl、DART-Europe.org、OATD.org）中检索未发表的研究和灰色文献。当研究ESWT治疗慢性中部跟腱病或慢性附着点性跟腱病的临床疗效时，随机对照试验（RCT）和非随机对照临床试验（CCT）符合纳入标准。我们排除了专注于治疗全身性疾病患者的研究，以及研究中部跟腱病和附着点性跟腱病混合队列且无法分别对两个临床实体进行亚组分析的研究。两名 reviewers 独立进行研究选择、质量评估、数据提取和证据水平分级。如有分歧，通过讨论解决，必要时咨询第三位 reviewer。
我们纳入了3项关于中部跟腱病的RCT和4项关于附着点性跟腱病的RCT。对于中部跟腱病，与标准治疗相比，ESWT总体有效性的证据质量为中等，VISA-A的合并平均差（MD）为9.08分（95%CI 6.35 - 11.81）。对中部跟腱病在标准治疗基础上加用ESWT的效果进行亚组分析，VISA-A的合并MD为10.28分（95%CI 7.43 - 13.12）。对于附着点性跟腱病，我们发现证据质量非常低，表明总体而言，ESWT与标准治疗相比没有额外价值，标准化平均差（SMD）为 - 0.02（95%CI - 0.27至0.23）。确定在标准治疗基础上加用ESWT对附着点性跟腱病效果的亚组分析显示，与单独标准治疗相比有负面影响（SMD - 0.29；95%CI - 0.56至 - 0.01）。
有中等证据支持在中部跟腱病的肌腱负荷计划基础上加用ESWT的有效性。缺乏支持ESWT对附着点性跟腱病有效性的证据。
PROSPERO数据库；编号CRD42021236107。
