Table 2

Mid-portion Achilles tendinopathy summary of evidence

OutcomesComparisonsRelative effect (95% CI)Patients /studies (n)Quality of evidence (GRADE)Clinical significance
Average estimate /assumed risk in the ESWT groupAverage estimate/assumed risk in the control group
VISA-A score
Follow-up: 4 months
ESWT: mean±SD was 70.4±16.3Eccentric load: mean±SD was 75.6±18.7MD −5.2
(14.92 to 4.52)
The difference was not statistically significant
50/1⊕⊕
Low1
Low level of evidence showed no difference between radial ESWT and eccentric training in VISA-A score
ESWT: mean±SD was 70.4±16.3Wait-and-see: mean±SD was 55.0±12.9MD 15.40
(7.25 to 23.55)
The difference was statistically and clinically significant
50/1⊕⊕
Low1
Low level of evidence in favour of radial ESWT compared with wait-and-see policy in VISA-A score
ESWT + eccentric load: mean±SD was 86.5±16.0Eccentric load: mean±SD was 73.0±19.0MD 13.50
(5.15 to 21.85)
The difference was statistically and clinically significant
68/1
Very low1,2
Very low level of evidence in favour of radial ESWT additive to eccentric training compared with eccentric training alone in VISA-A score
Self-perceived recovery
Defined as completely recovered and much improved
Follow-up: 4 months
ESWT: 13 of 25 (52%) participants reported satisfactory recoveryEccentric load: 15 of 25 (60%) participants reported satisfactory recoveryOR 0.72, (0.24 to 2.21)
The difference was not statistically significant
50/1⊕⊕
Low1
Low level of evidence showed no difference between radial ESWT and eccentric training in patient-rated recovery
ESWT: 13 of 25 (52%) participants reported satisfactory recoveryWait-and-see: 6 of 25 (24%) participants reported satisfactory recoveryOR 3.43
(1.03 to 11.48)
The difference was statistically significant
50/1⊕⊕
Low1
Low level of evidence in favour of radial ESWT compared with wait-and-see policy in patient-rated recovery
ESWT + eccentric load: 28 of 34 (82%) participants reported satisfactory recoveryEccentric load: 9 of 34 (26%) participants reported satisfactory recoveryOR 12.96
(4.04 to 41.57)
The difference was statistically significant
68/1
Very low1,2
Very low level of evidence in favour of radial ESWT additive to eccentric training compared with eccentric training alone in patient-rated recovery
NRS pain score*
Follow-up: 4 months
ESWT: mean±SD was 4.0±2.2Eccentric load: mean±SD was 3.6±2.3MD 0.40
(−0.85 to 1.65)
The difference was not statistically significant
50/1⊕⊕
Low1
Low level of evidence showed no difference in pain between radial ESWT and eccentric training in NRS score
ESWT: mean±SD was 4.0±2.2Wait-and-see: mean±SD was 5.9±1.8MD −1.90
(−3.01 to to 0.79)
The difference was statistically but not clinically significant
50/1⊕⊕
Low1
Low level of evidence in favour of radial ESWT compared with wait-and-see policy in NRS pain reduction, but not clinically significant
ESWT + eccentric load: mean±SD was 2.4±2.2Eccentric load: mean±SD was 3.9±2.0MD −1.50
(−2.50 to to 0.50)
The difference was statistically, but not clinically significant
68/1
Very low1,2
Very low level of evidence in favour of radial ESWT additive to eccentric training compared with eccentric training alone in NRS score, but not clinically significant
Patient-rated pain reduction**
Cut-off points adjusted from Farrar et al 44
Follow-up: 4 months
ESWT: MD from baseline was 2.8 pointsEccentric load: MD from baseline was 3.4 pointsNot estimable50/1N/AESWT: much improved
Eccentric load: much improved
ESWT: MD from baseline was 2.8 pointsWait-and-see: MD from baseline was 2.0 pointsNot estimable50/1N/AESWT: much improved
Wait-and-see: minimally improved
ESWT + eccentric load: MD from baseline was 4.4 pointsEccentric load: MD from baseline was 3.1 points Not estimable68/1N/AESWT + eccentric load: very much improved
Eccentric load: much improved
  • *Load-induced pain.

  • **Cut-off points adjusted from Farrar et al .44

  • 1 Only one high-quality randomised controlled trial was available for analysis.

  • 2 Indirect comparison.

  • ESWT, extracorporeal shockwave therapy; GRADE, Grading of Recommendations Assessment, Development and Evaluation; MD, mean difference; N/A, not available; NRS, numeric rating scale.