冲击波疗法治疗髌腱炎、跟腱炎和足底筋膜炎的有效性：系统评价和荟萃分析。
The effectiveness of shockwave therapy on patellar tendinopathy, Achilles tendinopathy, and plantar fasciitis: a systematic review and meta-analysis.
机构信息
School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
Engineering Research Centre of Traditional Chinese Medicine Intelligent Rehabilitation, Ministry of Education, Shanghai, China.
出版信息
Front Immunol. 2023 Aug 16;14:1193835. doi: 10.3389/fimmu.2023.1193835. eCollection 2023.
BACKGROUND
Tendinopathy is a growing global concern affecting many people, like athletes, workers, and the elderly. Despite its commonality among the sporting population, there is no practical clinical guideline for patellar tendinopathy (PT). Furthermore, there is conflicting evidence between clinical guidelines on shockwave therapy's application and clinical utility for Achilles tendinopathy (AT) and plantar fasciitis (PF). Thus, our aim of this study is to evaluate the evidence for shockwave therapy; to provide a Grading of Recommendation, Assessment, Development and Evaluation (GRADE) level of the evidence and effectiveness of shockwave therapy for patellar tendinopathy, Achilles tendinopathy, and Plantar fasciitis.
METHOD
Medical Literature Analysis and Retrieval System Online (Medline), Embase, The Cumulative Index to Nursing and Allied Health Literature (CINAHL), Physiotherapy Evidence Database (PEDro) and China National Knowledge Infrastructure database (CNKI) were searched to find relevant studies published before December 14, 2022.
RESULTS
Our study showed that for PT in the short term, extracorporeal shockwave therapy (ESWT) or ESWT + eccentric exercise (EE) has a negligible effect on pain and function compared to a placebo or placebo + EE. On the contrary, ESWT significantly affects pain compared to conservative treatment (CT). For AT, ESWT has a small inconclusive effect on pain and function in the short term compared to EE. On the other hand, a placebo outperformed ESWT in improving function for AT but not pain outcomes. PF showed that ESWT significantly affects short- and long-term pain and function. When ESWT was compared to other interventions such as low laser therapy (LLLT), corticosteroid injection (CSI), or CT, there was a small inconclusive effect on pain and function in the short term.
CONCLUSION
There is low-moderate evidence that ESWT has a negligible effect on pain and function for PT and AT. However, high-quality evidence suggests ESWT has a large effect on pain and function for PF.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023396835, identifier CRD42023396835.
背景
tendinopathy 是一种日益受到关注的全球性疾病，影响着许多人，如运动员、工人和老年人。尽管在运动人群中很常见，但对于髌腱病（PT）目前还没有实用的临床指南。此外，冲击波治疗在跟腱病（AT）和足底筋膜炎（PF）中的应用和临床效果方面，临床指南之间存在相互矛盾的证据。因此，我们的研究目的是评估冲击波治疗的证据；为髌腱病、跟腱病和足底筋膜炎提供冲击波治疗的推荐等级（GRADE）水平，以及评估冲击波治疗的效果。
方法
通过在线医学文献分析和检索系统（Medline）、Embase、护理和联合健康文献累积索引（CINAHL）、物理治疗证据数据库（PEDro）和中国知网（CNKI）搜索，寻找截至 2022 年 12 月 14 日发表的相关研究。
结果
我们的研究表明，在短期内，体外冲击波疗法（ESWT）或 ESWT+离心运动（EE）与安慰剂或安慰剂+EE 相比，对疼痛和功能的影响可以忽略不计。相反，ESWT 与保守治疗（CT）相比，对疼痛的影响更为显著。对于 AT，ESWT 在短期内对疼痛和功能的影响与 EE 相比具有较小的不确定性。另一方面，与 ESWT 相比，安慰剂在改善 AT 的功能方面效果更好，但对疼痛结果没有影响。PF 表明 ESWT 对短期和长期的疼痛和功能有显著影响。当 ESWT 与其他干预措施（如低水平激光治疗（LLLT）、皮质类固醇注射（CSI）或 CT）进行比较时，在短期内对疼痛和功能的影响存在较小的不确定性。
结论
有低到中等质量的证据表明，ESWT 对 PT 和 AT 的疼痛和功能的影响可以忽略不计。然而，高质量的证据表明，ESWT 对 PF 的疼痛和功能有很大的影响。
系统评价注册
https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023396835，标识符 CRD42023396835。
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