Date of Award

2023

Degree Type

Selective Evidence-Based Medicine Review

Degree Name

Master of Science in Health Sciences - Physician Assistant

Department

Physician Assistant Studies

Abstract

Objective: The objective of this selective EBM review is to determine “Does extracorporeal shock wave therapy (ESWT) reduce pain in patients diagnosed with Kellgren-Lawrence grades II or III knee osteoarthritis compared to placebo ESWT?”

Study Design: A systematic review of three randomized controlled trials (RCTs) published in peer-reviewed journals between 2013-2020

Data Sources: All articles were published in peer reviewed journals and researched using AltHealthWatch, AMED, CINAHL, MEDLINE and Rehabilitation and Sports Medicine Sources within EBSCOhost and PubMed. Studies were selected based on how well they answered the clinical question and if they discussed patient-oriented outcomes.

Outcome Measured: A reduction in knee pain was the outcome measured in all three studies using the 10-cm Visual Analog Scale (VAS) at 12 weeks after intervention. The mean change from baseline was calculated after obtaining VAS at 12 weeks.

Results: In the Zhang et al. RCT, ESWT had a small treatment effect due to a 1.8-point difference but provided a statistically significant reduction in pain due to p-values <0.001 when compared to the control group. The same was demonstrated in the study’s within-analysis due to a point difference of 1.6 plus a significant p-value <0.001 and narrow CI of 0.896-1.775 in placebo and 2.485-3.461 in ESWT groups. In the Uysal et al. RCT, ESWT had a small treatment effect due to a 1.4- and 1.6-point difference during rest and activity between the ESWT and control groups. However, ESWT provided a statistically significant reduction in pain both at rest and during activity due to p-values being 0.001 when compared to the control group. In the Zhao et al. RCT, ESWT had a small treatment effect due to a 2.59-point difference but provided a statistically significant reduction in pain during activity due to p-values being <0.001when compared to the control group.

Conclusion: The results found in all studies demonstrated that ESWT does reduce pain in adult men and women with Kellgren-Lawrence grades II and III knee osteoarthritis but the treatment effect is small. Future studies should explore efficacy of various ESWT regimens/doses, all severities of Kellgren-Lawrence scale, and compare ESWT with current knee osteoarthritis treatment modalities.

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