ESWT compared with traditional conservative treatment in proximal hamstring tendinopathy summary of evidence
| Outcomes | Comparisons | Relative effect (95% CI) | Patients /studies (n) | Quality of evidence (GRADE) | Clinical significance | |
| Average estimate /assumed risk in the ESWT group | Average estimate /assumed risk in the control group | |||||
| Nirschl phase rating Follow-up: 3 months | ESWT: mean±SD was 1.8±1.0 | Control: mean±SD was 5.5±1.2 | MD −3.70 (−4.38 to 3.02) The difference was clinically and statistically significant | 40/1 | ⊕⊕⊕ Moderate1,2 | Moderate level of evidence in favour of radial ESWT compared with control conservative treatment in Nirschl phase rating scale |
| Follow-up: 6 months | ESWT: mean±SD was 1.8±0.7 | Control: mean±SD was 5.6±1.7 | MD −3.80 (−4.61 to 2.99) The difference was clinically and statistically significant | 40/1 | ⊕⊕⊕ Moderate1,2 | Moderate level of evidence in favour of radial ESWT compared with control conservative treatment in Nirschl phase rating scale |
| Follow-up: 12 months | ESWT: mean±SD was 1.0±0.6 | Control: mean±SD was 5.4±2.6 | MD −4.40 (−5.57 to 3.23) The difference was clinically and statistically significant | 40/1 | ⊕⊕⊕ Moderate1,2 | Moderate level of evidence in favour of radial ESWT compared with control conservative treatment in Nirschl phase rating scale |
| Self-perceived recovery Follow-up: 6 months | ESWT: 16 of 20 (80%) participants reported satisfactory recovery | Control: 0 of 20 (0%) participants reported satisfactory recovery | OR 150.33 (7.54 to 2997.83) The difference was statistically significant | 40/1 | ⊕⊕⊕ Moderate1,2 | Moderate level of evidence in favour of radial ESWT compared with conservative management in patient-rated recovery |
| Follow-up: 12 months | ESWT: 16 of 20 (80%) participants reported satisfactory recovery | Control: 0 of 20 (0%) participants reported satisfactory recovery | OR 150.33 (7.54 to 2997.83) The difference was statistically significant | 40/1 | ⊕⊕⊕ Moderate1,2 | Moderate level of evidence in favour of radial ESWT compared with conservative management in patient-rated recovery |
| NRS score* Follow-up: 3 months | ESWT: mean±SD was 2.1±1.9 | Control: mean±SD was 6.8±2.2 | MD −4.70 (−6.04 to 3.36) The difference was clinically and statistically significant | 40/1 | ⊕⊕⊕ Moderate1,2 | Moderate level of evidence in favour of radial ESWT compared with control conservative treatment in pain scores |
| Follow-up: 6 months | ESWT: mean±SD was 1.8±1.1 | Control: mean±SD was 7.2±2.1 | MD −5.40 (−6.44 to 4.36) The difference was clinically and statistically significant | 40/1 | ⊕⊕⊕ Moderate1,2 | Moderate level of evidence in favour of radial ESWT compared with control conservative treatment in pain scores |
| Follow-up: 12 months | ESWT: mean±SD was 1.4±0.8 | Control: mean±SD was 6.8±2.3 | MD −5.40 (−6.47 to 4.33) The difference was clinically and statistically significant | 40/1 | ⊕⊕⊕ Moderate1,2 | Moderate level of evidence in favour of radial ESWT compared with control conservative treatment in pain scores |
| Patient-rated pain reduction** Follow-up: 3 months | Radial ESWT: MD from baseline was 5.0 points | Control: MD from baseline was 0.2 points | Not estimable | 40/1 | N/A | ESWT: very much improved Controls: minimally improved |
| Follow-up: 6 months | Radial ESWT: MD from baseline was 5.3 points | Control: MD from baseline was+0.2 points | Not estimable | 40/1 | N/A | ESWT: very much improved Controls: minimally worse |
| Follow-up: 12 months | Radial ESWT: MD from baseline was 5.7 points | Control: MD from baseline was 0.2 points | Not estimable | 40/1 | N/A | ESWT: very much improved Controls: minimally improved |
*Pain scores are referred to self-rated pain intensity score.
**Cut-off points adjusted from Farrar et al. 44
1 Only one randomised controlled trial included in analyses.
2Level of evidence increased due to the magnitude of effect.
ESWT, extracorporeal shockwave therapy; GRADE, Grading of Recommendations Assessment, Development and Evaluation; MD, mean difference; N/A, not available; NRS, numeric rating scale.