Zhu Pengcheng, Tang Peiyuan, Su Jingyue, Yang Yixin, Yang Shengwu, Zhang Chunwu, Xiao Wenfeng, Zhou Yang, Li Yusheng, Deng Zhenhan
Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, 410000, Hunan, China.
Xiangya School of Medicine, Central South University, Changsha, China.
J Orthop Traumatol. 2025 Aug 18;26(1):55. doi: 10.1186/s10195-025-00871-w.
The purpose of this study was to assess the methodological quality of meta-analyses (MAs) and resolve evidence inconsistencies by quantifying overlap in primary studies, thereby providing enhanced evidence on the efficacy of extracorporeal shockwave therapy (ESWT) versus placebo, ultrasound therapy, and corticosteroid injections for lateral epicondylitis.
We conducted searches in four databases: PubMed, Embase, Cochrane Library, and Web of Science, until August 2024. This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR 2) graded the quality and reliability of the MAs, and the quality of outcomes was graded by Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Graphical Representation of Overlap for OVErviews (GROOVE) was applied to analyze overlap and classified the resulting evidence into four categories (I-IV) on the basis of evidence classification criteria.
A total of nine MAs were included for analysis: five had a high AMSTAR 2 rating, three had a moderate AMSTAR 2 rating, and one had a low AMSTAR 2 rating. GROOVE analysis revealed substantial overlap, informing evidence classification. ESWT can effectively reduce the pain assessed by the visual analogue scale (VAS) compared with placebo (MD = -0.68; 95% CI -1.06, -0.3; P = 0.0004; I = 75%). Compared with ultrasound therapy, ESWT has a significantly large reduction in the level of pain after the treatment at 1-month follow-up (MD = -1.42; 95% CI -2.14, -0.7; P = 0.0001; I = 92%) and 3-month follow-up (MD = -1.65; 95% CI -1.81, -1.49; P < 0.00001; I = 98%). ESWT is better than corticosteroid injection when calculating the pooled effect size of VAS (SMD = 1.13, 95% Cl 0.72, 1.55; P < 0.00001; I = 0). ESWT also has a significant difference in the rate of 50% reduction in pain (RR = 1.38; 95% CI 1.09, 1.75; P = 0.008; I = 41%). However, compared with placebo, it has no clinically important difference of grip strength (MD = 3.33; 95% CI 0.93, 5.73; P = 0.007; I = 30%), and the pain score of Thomsen test (MD = -3.22; 95% CI -14.06, 7.62; P = 0.56; I = 69%).
ESWT has a significant difference in reducing pain evaluation and relief of pain symptoms, and the effect is better than ultrasound therapy and corticosteroid injections.
CRD42024586419.
本研究旨在评估荟萃分析（MAs）的方法学质量，并通过量化原始研究中的重叠部分来解决证据不一致的问题，从而提供关于体外冲击波疗法（ESWT）与安慰剂、超声疗法和皮质类固醇注射治疗外侧肱骨髁炎疗效的增强证据。
我们在四个数据库（PubMed、Embase、Cochrane图书馆和Web of Science）中进行检索，直至2024年8月。本综述遵循系统评价和荟萃分析的首选报告项目（PRISMA）指南。系统评价评估测量工具2（AMSTAR 2）对MAs的质量和可靠性进行评分，结局质量由推荐分级评估、制定和评价（GRADE）进行分级。综述重叠的图形表示（GROOVE）用于分析重叠情况，并根据证据分类标准将所得证据分为四类（I-IV）。
共纳入9项MAs进行分析：5项AMSTAR 2评分高，3项AMSTAR 2评分中等，1项AMSTAR 2评分低。GROOVE分析显示存在大量重叠，为证据分类提供了依据。与安慰剂相比，ESWT能有效降低视觉模拟量表（VAS）评估的疼痛（MD = -0.68；95%CI -1.06，-0.3；P = 0.0004；I = 75%）。与超声疗法相比，ESWT在1个月随访（MD = -1.42；95%CI -2.14，-0.7；P = 0.0001；I = 92%）和3个月随访（MD = -1.65；95%CI -1.81，-1.49；P < 0.00001；I = 98%）时治疗后疼痛水平显著大幅降低。计算VAS的合并效应量时，ESWT优于皮质类固醇注射（SMD = 1.13，95%Cl 0.72，1.55；P < 0.00001；I = 0）。ESWT在疼痛减轻50%的发生率方面也有显著差异（RR = 1.38；95%CI 1.09，1.75；P = 0.008；I = 41%）。然而，与安慰剂相比，其握力无临床重要差异（MD = 3.33；95%CI 0.93，5.73；P = 0.007；I = 30%），且Thomsen试验的疼痛评分无差异（MD = -3.22；95%CI -14.06，7.62；P = 0.56；I = 69%）。
ESWT在减轻疼痛评估和缓解疼痛症状方面有显著差异，且效果优于超声疗法和皮质类固醇注射。
本方案已在PROSPERO数据库注册：CRD42024586419。
