Effect of Shock Wave Therapy on Knee Osteoarthritis: A Systematic Review and Meta-analysis

Abstract

Objective: To examine the efficiency of shock wave therapy on pain and function in patients with primary knee osteoarthritis. Study design: Systematic review with Meta-analysis.

Data sources: An electronic search was done on PubMed and PEDro databases, and Cochrane Central Register of Controlled Trials (CENTRAL) on Cochrane from their inception till June 11,2020. Methods:A systematic review and meta-analysis was undertaken following the criteria proposed by Cochrane Handbook for Systematic Reviews of Interventions. Trials that meet the inclusion criteria: (1) randomized controlled studies; (2) a people with the diagnosis of Primary knee osteoarthritis; and (3) interventions that involved extracorporeal shockwave therapy were considered for review. When trials reported homogeneity on results measures, the mean differences or standardized mean differences with 95% confidence period were calculated and pooled in a meta-analysis for pooled synthesis.Results: Seven essays with a total of 520 contributors were involved in the review and only five trials were involved in the meta-analysis. Pain reduction was significant on visual analogue scale in all phases (immediate, short, medium and long terms) in Shock wave therapy groups versus the placebo/sham groups. However, Shockwave therapy impact on function in the pooled synthesis varied in different phases and on different scales, for WOMAC it showed significant improvement in the treated group at all phases except the medium term, for Lequesne index ESWT had no statistically significant effect at all phases except long term, for KOOS it showed significant improvement in immediate phase,and finally for 20 m walk test only one study used it and showed significant improvement in all phases.Conclusion: The meta-analysis suggests that ESWT has a statistically significant effect on pain reduction in all four phases(immediate, short, medium and long term) using VAS scale as well as significant improvement in function in all phases on WOMAC except medium term, and on KOOS in the immediate phase, and on 20 m walk test in all phases, however there was no statistically significant effect in the pooled synthesis regarding Lequesne index in immediate, short and medium phases