Knee osteoarthritis: shockwave therapy safe, effective in meta-analysis

  • Liao CD & al.
  • Clin Rehabil
  • 8 May 2019

  • International Clinical Digest
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Takeaway

  • Extracorporeal shockwave therapy for patients with knee osteoarthritis (KOA) delivers greater treatment success, pain reduction, and functional improvement vs placebo or active comparator.
  • This therapy is not accompanied by any clinically relevant adverse effects.

Why this matters

  • Shockwave therapy is a useful therapeutic option for KOA.

Study design

  • Meta-analysis and meta-regression of 50 randomized controlled trials (n=4844 participants), after search of MEDLINE, PubMed, EMBASE, Cochrane Library, Physiotherapy Evidence Database (PEDro), among others.
  • Funding: None.

Key results

  • Shockwave therapy yielded more than 3-fold higher success rate than placebo or active comparator (OR, 3.22; P<.00001 i>2=62%).
  • Shockwave therapy yielded greater pain reduction by visual analog scale or patient-reported scale (standardized mean difference [SMD], −2.02; P<.00001 i>2=95%) vs controls.
  • Shockwave therapy yielded greater functional improvement on the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC; SMD, −2.34; P<.00001 i>2=96%) vs controls.
  • In meta-regression, longer follow-up duration was a better predictor of shockwave therapy efficacy (OR, 5.37; P<.00001 than immediate follow-up p=".0007)," as was energy flux density on the effect size of pain score logarithm or r>2=27.5%; P≤.001) and WOMAC function index (R2=33.7%; P≤.001).
  • Shockwave therapy was unaccompanied by clinically relevant adverse events.

Limitations

  • High heterogeneity across studies.