Department of Medicine and Health Science "Vincenzo Tiberio", University of Molise c/o Cardarelli Hospital, Campobasso, Italy.
Department of Clinical Sciences and Translational Medicine, University of Roma "Tor Vergata" c/o Medicine and Surgery School, Roma, Italy.
Physiother Res Int. 2024 Jul;29(3):e2106. doi: 10.1002/pri.2106.
To investigate if Extracorporeal Shock Wave therapy (ESWT) is effective in reducing pain and disability, in improving function, quality of life and complete resorption rate of calcification in patients with Rotator Cuff Calcific Tendinopathy. To investigate which modality of ESWT brings the greatest clinical improvements between High (HE)-SWT and Low Energy (LE)-SWT and between Focal (F)-SWT and Radial (R)-SWT.
MEDLINE, EMBASE, CENTRAL Database, and PEDro databases until February 2024 were searched. Study registers were further investigated. The Risk of Bias (RoB) was assessed with the Revised Cochrane RoB Tool (RoB 2). The certainty of evidence was rated with GRADE.
Twenty-one randomized controlled trials were included. None was judged as overall low RoB. Comparing ESWT and Ultrasound Guided Needling Procedures (USGNP), the pooled results reported a significant difference favoring USGNP in pain at <24 and <48 weeks (MD = 1.17, p = 0.004, I = 59%; MD = 1.31, p = 0.004, I = 42%, respectively). Comparing ESWT and sham-ESWT, the pooled results reported a clinically significant difference favoring ESWT in pain and function at 24 weeks (MD = -5.72, p < 0.00001, I = 0%; Standardized Mean Difference = 2.94, p = 0.02 I = 98%, respectively). Comparing HE-SWT and LE-SWT, HE-SWT was statistically and clinically superior in pain and function at <24 weeks (MD = -1.83, p = 0.03, I = 87%; MD = 14.60, p = 0.002, I = 77%, respectively) and showed a significantly higher complete resorption rate of calcification at 12 weeks (Risk Ratio = 2.53, p = 0.001, I = 0%). F-SWT and R-SWT appear equally effective in reducing pain, improving disability and resorption rate. The certainty of evidence was rated as very low through GRADE approach.
USGNP was statistically superior to ESWT in pain reduction at <24 and <48 weeks. ESWT was clinically better to sham-ESWT in pain reduction and function improvement at 24 weeks. HE-SWT was clinically more effective than LE-SWT in reducing pain, improving function at <24 weeks, and resolving calcific deposits at 12 weeks, while no differences between F-SWT and R-SWT were reported.
研究体外冲击波疗法 (ESWT) 是否能有效减轻疼痛和残疾，改善功能、生活质量以及钙化完全吸收率在肩袖钙化性肌腱炎患者中的作用。研究哪种 ESWT 模式在高能量 (HE)-SWT 和低能量 (LE)-SWT 之间以及焦点 (F)-SWT 和放射状 (R)-SWT 之间带来最大的临床改善。
检索了 MEDLINE、EMBASE、CENTRAL 数据库和 PEDro 数据库截至 2024 年 2 月的数据，并进一步调查了研究登记处。使用修订后的 Cochrane 偏倚风险工具 (RoB 2) 评估偏倚风险 (RoB)。使用 GRADE 方法对证据的确定性进行评级。
共纳入 21 项随机对照试验。没有一项被判定为整体低 RoB。与超声引导下针刺治疗 (USGNP) 相比，汇总结果报告在 24 周和 48 周时疼痛方面 ESWT 更有利于 USGNP（MD = 1.17，p = 0.004，I = 59%；MD = 1.31，p = 0.004，I = 42%）。与假 ESWT 相比，汇总结果报告在 24 周时 ESWT 在疼痛和功能方面具有临床意义的改善（MD = -5.72，p < 0.00001，I = 0%；标准化均数差 = 2.94，p = 0.02，I = 98%）。与 HE-SWT 和 LE-SWT 相比，HE-SWT 在 24 周时在疼痛和功能方面具有统计学和临床优势（MD = -1.83，p = 0.03，I = 87%；MD = 14.60，p = 0.002，I = 77%），并在 12 周时显示出更高的钙化完全吸收率（风险比 = 2.53，p = 0.001，I = 0%）。F-SWT 和 R-SWT 在减轻疼痛、改善残疾和吸收率方面似乎同样有效。通过 GRADE 方法，证据的确定性被评为极低。
在 24 周和 48 周时，USGNP 在疼痛缓解方面优于 ESWT。ESWT 在 24 周时在减轻疼痛和改善功能方面优于 sham-ESWT。在 24 周时，HE-SWT 在减轻疼痛、改善功能方面比 LE-SWT 更有效，在 12 周时更能解决钙化沉积，但 F-SWT 和 R-SWT 之间没有差异。
