It has been argued that focused shockwave therapy and radial shockwave therapy should be viewed as distinctly different therapeutic modalities. Focused and radial shockwave (radial pressure waves) are two technically distinct forms of SWT. Shockwave Therapy (SWT) is used to treat a range of musculoskeletal conditions. Registration number: PROSPERO CRD42018091140. Lack of adequate reporting of imaging outcomes limited the conclusions that could be drawn from the current review. The parameters of SWT dosage are not significant predictors of changes in imaging outcomes. SWT altered the morphology of musculoskeletal conditions, potentially reflecting changes in underlying pathophysiological processes. Meta-regression showed no influence of SWT dosage parameters, however, baseline lesion size was an independent predictor for changes in imaging outcomes. There was an overall reduction in the size of measured lesion following SWT (MD 8.44 mm (95%CI 4.30, 12.57), p < 0.001) for calcium deposit diameter, (MD 0.92 mm (95%CI 0.03, 1.81), p = 0.04) for plantar fascia thickness and (MD 4.84% (95%CI -0.06, 9.75), p = 0.05) for lesion size in femoral head osteonecrosis. Meta-analyses and meta-regression on imaging outcomes were performed for rotator cuff calcific tendinitis ( n = 11), plantar fasciitis ( n = 7) and osteonecrosis of the femoral head ( n = 9). Sixty-three studies were included, with data from 27 studies available for effect size pooling. Random-effects meta-analysis and meta-regression with a priori determined covariates was conducted for each condition to determine potential predictors of SWT effects. Articles were evaluated independently for risk of bias using the Cochrane Risk of Bias list and the Methodological Index for Non-Randomized Studies. Prospective clinical trials evaluating the effectiveness of SWT based on changes in imaging outcomes were eligible for inclusion. MethodsĪ comprehensive search of Medline, Embase, Cochrane Controlled Trials Register, CINAHL and SportDiscus was conducted from inception to October 2018. The objective of the current review is to evaluate changes in imaging outcomes of musculoskeletal conditions following SWT. However, the capacity of SWT to influence pathophysiological processes and the morphology of affected tissues remains unclear. Shockwave therapy (SWT) is a commonly used intervention for a number of musculoskeletal conditions with varying clinical outcomes.
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