Review article (meta-analysis)
Is Extracorporeal Shock Wave Therapy Clinical Efficacy for Relief of Chronic, Recalcitrant Plantar Fasciitis? A Systematic Review and Meta-Analysis of Randomized Placebo or Active-Treatment Controlled Trials

https://doi.org/10.1016/j.apmr.2014.01.033Get rights and content

Abstract

Objective

To assess the efficacy of extracorporeal shockwave therapy (ESWT) and provide clinicians with an evidence base for their clinical decision making.

Data Sources

PubMed, MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and Evidence-Based Medicine Reviews.

Study Selection

All randomized or quasi-randomized controlled trials of ESWT for chronic recalcitrant plantar fasciitis were searched. Searching identified 108 potentially relevant articles; of these, 7 studies with 550 participants met inclusion criteria.

Data Extraction

Number of patients, population, body mass index, duration of symptoms, adverse effects, blinding method, and details of shockwave therapy were extracted.

Data Synthesis

For intervention success rate, ESWT of low intensity was more effective than control treatment of low intensity. For pain relief, the pooled data showed a significant difference between the ESWT and control groups. For function, only low-intensity ESWT was significantly superior over the control treatment.

Conclusions

The efficacy of low-intensity ESWT is worthy of recognition. The short-term pain relief and functional outcomes of this treatment are satisfactory. However, owing to the lack of a long-term follow-up, its long-term efficacy remains unknown.

Section snippets

Search strategy

We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations for this meta-analysis.42 With the assistance of a medical research librarian, we performed serial literature searches for English and non-English articles. The following electronic databases were searched from their inception dates to April 2013: PubMed, MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and Evidence-Based Medicine Reviews. We used Boolean logic with search

Study description

From an initial search yield of 108 articles, 53 potentially relevant articles were identified. After reading the titles and abstracts, 23 studies were identified as RCTs. Among these, 11 lacked a clear definition of successful treatment standards. Two studies compared local ESWT with radial ESWT for the treatment of plantar fasciitis, and 3 studies used a local anesthetic in the ESWT group. After exclusion of these studies, the 7 remaining studies with adequate methodology were incorporated in

Summary of the main findings

We used 5 levels of evidence to assess whether treatment was beneficial: strong evidence (consistent findings in several high-quality RCTs), moderate evidence (findings from 1 high-quality RCT or consistent findings in several low-quality trials), limited evidence (1 low-quality RCT), unclear evidence (inconsistent or contradictory results in several randomized trials), and no evidence (no studies identified).

The results of the present review showed strong statistical evidence for the efficacy

Conclusions

This meta-analysis provides substantive clinical evidence for clinicians in the treatment of chronic, recalcitrant plantar fasciitis. The results show that the efficacy of low-intensity ESWT is worthy of recognition. The short-term pain relief and functional outcomes of this treatment are satisfactory. However, owing to the lack of a long-term follow-up, its long-term efficacy remains unknown.

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  • Cited by (0)

    Supported by the Project of Shanghai City Health System Excellent Discipline Leader Training (grant no. XBR2013104) and the Construction of The National Five Years' Major Drug Discovery Projects-Chinese Medicine (malignant tumor disease) Clinical Evaluation (grant no. 2011ZX09302-006-04).

    Disclosures: none.

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