Extracorporeal Shockwave Therapy

The Extracorporeal shockwave Therapy recommendation has been downgraded two levels because of inconsistent evidence and a lack of internal consistency with recommendations of equal supporting evidence.

A meta-analysis was performed using pain data from three high quality studies (Zhong 2019, Ediz 2018, and Uysal 2020) in which Extracorpeal Shockwave Therapy (ESWT) was compared to sham ESWT in subjects with knee osteoarthritis. The results of the meta-analysis can be seen in Figure 19 in the appendix. The overall findings were in favor of receiving ESWT for reducing pain in subjects with knee osteoarthritis. In addition, four high quality studies reported greater improvements in function scores in subjects receiving ESWT compared to the sham group at 4 to 12 weeks but not at 1-year follow-up. (Zhao 2013, Ediz 2018, Zhong 2019, Uysal 2020).

Benefits/Harms of Implementation

Patients receiving this treatment may experience improvements in pain and function. Side effects may include redness or mild bruising, swelling, pain, numbness or tingling in the treated area, migraine headaches, and syncope.

Acceptability

Generally tolerated well but some patients may experience side-effects listed above.

Feasibility

The intervention is considered feasible but may not be widely available in clinics managing patients with knee osteoarthritis and therefore may not be accessible for all patients.

Future Research

Future studies should examine methods to sustain longer term effects of the intervention (e.g., optimal dosage, use of booster interventions), investigate the potential of ESWT as an osteoarthritis disease-modifying agent, and identify characteristics of patients that may discriminate between responders and non-responders of the intervention. The mechanisms of action of these interventions in human subjects is not well understood. Future studies investigating the mechanisms of action of these interventions in human subjects would be helpful.