Abstract
Background A review of literature for in-office, low to medium energy (.04mj/mm2 to .4mj/mm2) Extracorporeal Shockwave Therapy (ESWT) shows a substantial body of evidence suggesting strong efficacy and safety for the use of this form of Acoustic Compression Therapy. Much of this evidence is focused on the treatment of a specific region of the body, such as lateral epicondylitis, plantar fasciitis, and shoulder tendinopathies. This evaluation is designed to address the clinical utility of low to medium energy ESWT in an outpatient health care office setting, including delivery to multiple regions of the body, and for patients considered good candidates based on the failure of at least six months of prior conservative care.
Methods Ordinary least squares (OLS) models with errors clustered at the patient level estimate the association between shockwave treatments and patient-reported pain levels. Additional models utilizing polynomial treatment indicators test for a non-linear relationship between treatment number and reported pain level.
Results For the sixty-one patients represented in this analysis, the mean reduction in pain was 2.3 points on a 10 point scale, representing a 47% reduction in average reported pain levels. Results suggest that each treatment is associated with a 0.33 point reduction in reported pain levels (on a 10 point scale), controlling for patient demographics and treatment intensity. Additional models utilizing polynomial treatment indicators suggest a non-linear relationship between treatment number and reported pain level, indicating that the initial benefit of treatment is a 0.67 point reduction in pain for the first treatment, and falling slightly with each subsequent treatment. A subset of patients responded to follow up requests to ascertain reported pain levels at least three months after the final treatment. All patients were contacted, out of which 24 responded, reporting average pain levels of 2.9 out of 10, a substantial improvement from initial reported pain levels following final treatment (4.0), representing a decrease of 28%.
Conclusion The results suggest the use of Acoustic Compression at these doses on properly selected cases can improve clinical outcomes for conservatively treated patients who may otherwise end up requiring more aggressive measures in the absence of ESWT. Evidence reviewed suggests that continued healing time leads to further improvement.
Competing Interest Statement
The authors have declared no competing interest.
Funding Statement
Funding for the article was provided by Richard Wolf. All research work, including data collection, analysis, and publication, was conducted independently.
Author Declarations
I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.
Yes
The details of the IRB/oversight body that provided approval or exemption for the research described are given below:
This study was approved by Life Chiropractic College West, 25001 Industrial Blvd, Hayward, CA 94545. IRB reference number PN 2012-10.
All necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived.
Yes
I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).
Yes
I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable.
Yes
Data Availability
Individual patient data is HIPPAA protected and not available to be made public. Sample pain scale and patient intake documentation available upon request.
List of Abbreviations
- ESWT
- Extracorporeal Shockwave Therapy