RESUMO
OBJECTIVE: To investigate extracorporeal shock wave therapy effect on knee osteoarthritis compared to a sham or kinesiotherapy by a systematic review and meta-analysis of randomized clinical trials. DATA SOURCES: The search was performed in: Cochrane Library, PubMed, PEDro, Web of Science, EMBASE, Scopus, LILACS, and Scielo. REVIEW METHODS: We performed the online search until October, 2022. The following terms were used (Osteoarthritis) AND ("knee joint") AND ("Extracorporeal Shockwave Therapy"). Eligibility criteria: (1) randomized clinical trials; (2) effects comparison of shockwave therapy to a sham or kinesiotherapy in individuals with knee osteoarthritis; (3) pain and physical function as outcome variables. Risk of bias assessed using the PEDro scale. PROSPERO registration (CRD42021235597). RESULTS: We identified 4217 studies, and 12 were included in the qualitative synthesis and the meta-analysis, totaling 403 individuals submitted to the intervention and 331 control individuals. Compared to sham, shockwave was favored in short-term for the function outcome (SMD = -1.93; 95%CI: [-2.77; -1.09]; I² = 83%; P < 0.01). For the pain outcome, the shockwave was favored in the short (MD = -2.05; 95%CI: [-2.59; -1.51]; I² = 84%; P < 0.01), medium (MD = -3.46; 95%CI: [-4.03; -2.89]; I² = 0%; P < 0.01) and long-term (MD = -2.01; 95%CI: [-3.36; -0.65]; I² = 98%; P < 0.01). The association with kinesiotherapy was favored in the short term for the function outcome (SMD = -1.88; 95%CI: [-2.98; -0.78]; I² = 94%; P < 0.01) and favored for the pain outcome in the short (MD = -1.44; 95%CI: [-1.81; -1.07]; I² = 37%; P = 0.14), medium (MD = -1,31; 95%CI: [-1.76; -0,85]; I² = 0%; P = 0.41), and long terms (MD = -1.63; 95%CI: [-1.73; -1.52]; I² = 0%; P = 0.43). CONCLUSION: Shockwave therapy may improve functionality in patients with knee osteoarthritis in the short term and pain in all follow-up moments, compared with sham. When associated to kinesiotherapy, it may improve function in the short term and pain in all follow-up time points, although improvement in pain may not be clinically significant.
Assuntos
Tratamento por Ondas de Choque Extracorpóreas , Osteoartrite do Joelho , Humanos , Osteoartrite do Joelho/tratamento farmacológico , Tratamento por Ondas de Choque Extracorpóreas/efeitos adversos , Articulação do Joelho , Dor/etiologiaRESUMO
Extracorporeal shock waves are unique sound waves that generate a rapid increase in pressure in the tissues in which they are applied. They were first used on the management of urolithiasis and later spread to other pathologies such as musculoskeletal. A series of studies have been carried out to support the usefulness of shock waves in patients with plantar fasciitis, Achilles tendinopathy, epicondylitis, rotator cuff injury with or without calcification, patellar tendinopathy and peritrochanteric pathology that has lasted more than three months and have not responded to the initial handling. There is no consensus regarding the specific protocols to be used. In these conditions, shock waves are only a part of a comprehensive treatment, and should always be associated with other conventional therapies. (AU)