Efficacy of extracorporeal shock wave for non-specific low back pain: a systematic review and Meta-analysis

doi:10.3877/cma.j.issn.2096-0263.2023.05.009

Abstract

Abstract:

Objective

The article investigates the clinical effectiveness of extracorporeal shock wave treatment for non-specific low back pain through Meta-analysis, with a view to providing evidence-based evidence for clinical treatment.

Methods

Computer searches of PubMed, Web of science, Embase, Cochrane Library and China Knowledge Network, Vipshop and Wanfang databases were conducted to collect randomized controlled trials of extracorporeal shock wave for low back pain, and the search time frame was from the establishment of each database to March 12, 2023, and the Cochrane Risk of Bias Tool and Jadad were used to The quality of the included literature was evaluated using the Cochrane Risk of Bias Tool and Jadad scale, and Meta-analysis was performed using Revman 5.4 software.

Results

14 eligible randomized controlled trials involving 642 patients were included, including 324 in the intervention group and 318 in the control group. Meta-analysis results showed that compared with the control group, extracorporeal shock wave significantly improved pain levels in patients with low back pain (SMD=-0.90, 95% CI: -1.07, -0.74, P<0.001), the Oswestry Dysfunction Index (MD=-6.61, 95% CI: -9.19, -4.03, P<0.001), Beck Depression Scale score (MD=-3.84, 95% CI: -5.37, -1.97, P<0.001) and 36-item Brief Health Survey scale score (MD=8.51, 95% CI: 7.82, 9.20, P<0.001), but did not significantly improve patients' finger-ground distance (MD= -2.65, 95% CI: -7.57, 2.26, P=0.29).

Conclusions

Extracorporeal shock waves can improve the level of pain, dysfunction, depression and quality of life in patients with low back pain, but further studies are needed to prove the improvement effect on low back flexibility.

Key words: Extracorporeal shock wave, Low back pain, Therapeutic effect, Meta-analysis

Hongli Xu, Yulin Yang, Qing Xue, Qian Zhang, Lihong Ma, Zhengang Qiu. Efficacy of extracorporeal shock wave for non-specific low back pain: a systematic review and Meta-analysis[J]. Chinese Journal of Geriatric Orthopaedics and Rehabilitation(Electronic Edition), 2023, 09(05): 307-314.

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Figures/Tables 6

References 59

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纳入文献	样本量	年龄（岁）		性别（男/女，例）
纳入文献	干预组/对照组	干预组	对照组	干预组	对照组
Kiziltas^[30]，2022	36/34	47.4±14.3	45.3±12.2	23/13	14/20
Rajfur^[31]，2022	20/20	42.3±13.1	45.4±14	10/10	10/10
Taheri^[32]，2021	17/15	42.5±10.1	37.1±11.8	6/11	9/6
Elgendy^[33]，2020	15/15	32.73±6.73	33.26±5.48	10/5	10/5
Eftekharsadat^[34]，2020	27/27	44.74±9.34	45.04±11.86	7/20	10/17
Çelik^[35]，2020	25/20	40.76±10.68	40.25±10.26	15/10	8/12
Walewicz^[36]，2019	20/20	51.1±8.4	55.8±9.3	6/14	5/15
Schneider^[37]，2018	15/15	-	-	-	-
Han^[43]，2015	15/15	49.7±8.3	46.0±8.9	-	-
Lee^[38]，2014	13/15	53.92±10.38	54.33±13.16	-	-
李祖虹^[39]，2019	32/32	59.5±9.5	58.8±9.6	19/13	17/15
王宁^[40]，2019	30/30	49.7±8.3	46.0±8.9	14/16	16/14
杨杰华^[41]，2015	27/29	33.27±10.12	33.27±9.63	2/27	3/26
郑志新^[42]，2013	32/31	45.84±11.85	47.39±12.69	18/14	16/15
纳入文献	干预措施		ESWT治疗参数	结局指标
纳入文献	干预组	对照组	ESWT治疗参数	结局指标
Kiziltas^[30]，2022	ESWT，每周2次，共5次	常规康复	剂量2600次，频率10Hz，压强2.8bar	①②③④
Rajfur^[31]，2022	ESWT，每周2次，共10次	常规康复	剂量1000次，频率4Hz，能量0.15mJ/mm²	①②
Taheri^[32]，2021	ESWT，每周1次，共4次	假治疗	剂量1500次，频率4Hz，能量0.15mJ/mm²	①②
Elgendy^[33]，2020	ESWT，每周2次，共12次	常规康复	剂量2000次，频率5Hz，能量0.1mJ/mm²	①
Eftekharsadat^[34]，2020	ESWT，每周1次，共5次	类固醇注射	剂量1500次，频率10-16Hz，能量0.1mJ/mm²	①②⑤
Çelik^[35]，2020	ESWT，每周2次，共12次	安慰剂	剂量1500次，频率2.5Hz，能量0.12mJ/mm²	①②
Walewicz^[36]，2019	ESWT，每周2次，共10次	假治疗	剂量2000次，频率5Hz，能量0.1mJ/mm²	①②
Schneider^[37]，2018	ESWT，每周2次，共6次	常规康复	频率15-42Hz	①
Han^[43]，2015	ESWT，每周2次，共12次	常规康复	剂量1000次，频率2.5Hz，能量0.01-0.16mJ/mm²	①②③
Lee^[38]，2014	ESWT，每周2次，共12次	常规康复	剂量2000次，频率5Hz，能量0.1mJ/mm²	①
李祖虹^[39]，2019	ESWT，每周2次，共4次	常规康复	剂量1500-2500次，频率5-15Hz，压强1.2-2.0kPa	①⑤
王宁^[40]，2019	ESWT，每周1次，共4次	常规康复	剂量1000次，频率2.5Hz，能量0.01-0.16mJ/mm²	①②③
杨杰华^[41]，2015	ESWT，每周2次，共6次	常规康复	剂量1800-2500次，频率90次/min，根据耐受度选择能量强度	①
郑志新^[42]，2013	ESWT，每周2次，共4次	常规康复	剂量2000次，频率8-12Hz，压强1.6-3.0bar	①④

纳入文献	样本量	年龄（岁）		性别（男/女，例）
纳入文献	干预组/对照组	干预组	对照组	干预组	对照组
Kiziltas^[30]，2022	36/34	47.4±14.3	45.3±12.2	23/13	14/20
Rajfur^[31]，2022	20/20	42.3±13.1	45.4±14	10/10	10/10
Taheri^[32]，2021	17/15	42.5±10.1	37.1±11.8	6/11	9/6
Elgendy^[33]，2020	15/15	32.73±6.73	33.26±5.48	10/5	10/5
Eftekharsadat^[34]，2020	27/27	44.74±9.34	45.04±11.86	7/20	10/17
Çelik^[35]，2020	25/20	40.76±10.68	40.25±10.26	15/10	8/12
Walewicz^[36]，2019	20/20	51.1±8.4	55.8±9.3	6/14	5/15
Schneider^[37]，2018	15/15	-	-	-	-
Han^[43]，2015	15/15	49.7±8.3	46.0±8.9	-	-
Lee^[38]，2014	13/15	53.92±10.38	54.33±13.16	-	-
李祖虹^[39]，2019	32/32	59.5±9.5	58.8±9.6	19/13	17/15
王宁^[40]，2019	30/30	49.7±8.3	46.0±8.9	14/16	16/14
杨杰华^[41]，2015	27/29	33.27±10.12	33.27±9.63	2/27	3/26
郑志新^[42]，2013	32/31	45.84±11.85	47.39±12.69	18/14	16/15
纳入文献	干预措施		ESWT治疗参数	结局指标
纳入文献	干预组	对照组	ESWT治疗参数	结局指标
Kiziltas^[30]，2022	ESWT，每周2次，共5次	常规康复	剂量2600次，频率10Hz，压强2.8bar	①②③④
Rajfur^[31]，2022	ESWT，每周2次，共10次	常规康复	剂量1000次，频率4Hz，能量0.15mJ/mm²	①②
Taheri^[32]，2021	ESWT，每周1次，共4次	假治疗	剂量1500次，频率4Hz，能量0.15mJ/mm²	①②
Elgendy^[33]，2020	ESWT，每周2次，共12次	常规康复	剂量2000次，频率5Hz，能量0.1mJ/mm²	①
Eftekharsadat^[34]，2020	ESWT，每周1次，共5次	类固醇注射	剂量1500次，频率10-16Hz，能量0.1mJ/mm²	①②⑤
Çelik^[35]，2020	ESWT，每周2次，共12次	安慰剂	剂量1500次，频率2.5Hz，能量0.12mJ/mm²	①②
Walewicz^[36]，2019	ESWT，每周2次，共10次	假治疗	剂量2000次，频率5Hz，能量0.1mJ/mm²	①②
Schneider^[37]，2018	ESWT，每周2次，共6次	常规康复	频率15-42Hz	①
Han^[43]，2015	ESWT，每周2次，共12次	常规康复	剂量1000次，频率2.5Hz，能量0.01-0.16mJ/mm²	①②③
Lee^[38]，2014	ESWT，每周2次，共12次	常规康复	剂量2000次，频率5Hz，能量0.1mJ/mm²	①
李祖虹^[39]，2019	ESWT，每周2次，共4次	常规康复	剂量1500-2500次，频率5-15Hz，压强1.2-2.0kPa	①⑤
王宁^[40]，2019	ESWT，每周1次，共4次	常规康复	剂量1000次，频率2.5Hz，能量0.01-0.16mJ/mm²	①②③
杨杰华^[41]，2015	ESWT，每周2次，共6次	常规康复	剂量1800-2500次，频率90次/min，根据耐受度选择能量强度	①
郑志新^[42]，2013	ESWT，每周2次，共4次	常规康复	剂量2000次，频率8-12Hz，压强1.6-3.0bar	①④

纳入文献	随机序列产生	隐藏分配	盲法	退出与失访	总分	质量
Kiziltas^[30]，2022	1	2	1	1	5	高
Rajfur^[31]，2022	2	2	1	1	6	高
Taheri^[32]，2021	2	2	1	1	6	高
Elgendy^[33]，2020	2	1	1	1	5	高
Eftekharsadat^[34]，2020	2	2	1	1	6	高
Çelik^[35]，2020	2	2	2	1	7	高
Walewicz^[36]，2019	2	1	1	1	5	高
Schneider^[37]，2018	2	1	1	1	5	高
Han^[43]，2015	1	1	1	1	4	高
Lee^[38]，2014	1	1	1	1	4	高
李祖虹^[39]，2019	1	1	1	1	4	高
王宁^[40]，2019	2	2	1	1	6	高
杨杰华^[41]，2015	1	1	1	1	4	高
郑志新^[42]，2013	2	2	1	1	6	高

纳入文献	随机序列产生	隐藏分配	盲法	退出与失访	总分	质量
Kiziltas^[30]，2022	1	2	1	1	5	高
Rajfur^[31]，2022	2	2	1	1	6	高
Taheri^[32]，2021	2	2	1	1	6	高
Elgendy^[33]，2020	2	1	1	1	5	高
Eftekharsadat^[34]，2020	2	2	1	1	6	高
Çelik^[35]，2020	2	2	2	1	7	高
Walewicz^[36]，2019	2	1	1	1	5	高
Schneider^[37]，2018	2	1	1	1	5	高
Han^[43]，2015	1	1	1	1	4	高
Lee^[38]，2014	1	1	1	1	4	高
李祖虹^[39]，2019	1	1	1	1	4	高
王宁^[40]，2019	2	2	1	1	6	高
杨杰华^[41]，2015	1	1	1	1	4	高
郑志新^[42]，2013	2	2	1	1	6	高

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